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Young people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.
Objectives...
Context in source publication
Context 1
... 2 Scoping review methodology I n this chapter we give an overview and details of the methodology that we used to conduct this scoping review. The work comprises a review of literature to find, appraise and synthesise available evidence on digital interventions for sexual health for young people, integrating the findings with key informant views (both professional and lay) (Figure 3). ...
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Citations
... DBCIs enable participation at users' convenience, provide anonymity, and alleviate fears of stigmatisation. They also offer the added advantage of delivering consistent and standardised information, with implementation costs typically lower than for traditional methods [9]. Recognising the increasing use of the internet for accessing health information, National Health Service (NHS) England underscores the importance of harnessing digital technologies in all aspects of healthcare delivery [10]. ...
Background
Correct and consistent condom use is the most effective method to reduce transmission of sexually transmitted infections (STIs).
Objective
To compare the HIS-UK intervention to usual condom information and distribution care for effect on chlamydia test positivity.
Methods
Trial design
A 3-parallel arm randomised controlled trial (1:1:1 allocation, two intervention arms vs. control). Randomisation using permuted blocks of varying lengths, with stratification by site, ethnicity and sexual-partnering risk. Repeated measures design with monthly follow-up to six months post-randomisation.
Setting
Sexual health services in seven NHS Trusts and one university medical centre. Telephone and video consultations, online and in participants’ homes in England, UK.
Participants
Target sample of 2231 men and people with penises, aged 16-25, at risk of STIs.
Intervention
HIS-UK delivered (1) face-to-face by health professionals (proHIS) or (2) digitally (eHIS). Two-weeks self-practice and experimentation using the HIS-UK condom kit.
Primary health outcome
Chlamydia test positivity by six-months.
Secondary outcomes
Frequency of unprotected sexual intercourse, reported condom use errors and problems, attitudes and use experience.
Analyses
Chlamydia test positivity by six months analysed by logistic regression. Secondary outcomes analysed using linear mixed effects models with fixed effects and a random effect for the repeated measures, and generalised estimating equations with a logit link, adjusting for fixed effects and specifying an autoregressive-1 correlation structure.
Results
725 participants (proHIS:241, eHIS:243, control:241) randomised. 575 participants completed all baseline activities, 189 (32.9%) reached six-months post-randomisation.
The absolute difference in chlamydia test positivity between arms was -4.9 percentage points at six months (7.9% HIS-UK, 12.8% control). The odds of chlamydia test positivity during follow-up were 55% lower for HIS-UK participants (p=.261).
HIS-UK showed a positive impact on recent condom use over time (p<.001). Significant reductions in condom errors and problems among HIS-UK participants were observed (p=.035). Lubricant use increased among HIS-UK participants, with evidence of an intervention-by-time interaction (p=.051), and a decline in poor condom fit and feel reports, but without intervention effect.
Compared to control participants, HIS-UK participants showed enhanced and sustained positive condom attitudes, reduced perceived barriers, and increased confidence in condom use, during follow-up; these changes were statistically significant.
Conclusions
This study provides valuable insights into the potential of HIS-UK to enhance sexual health practices among at-risk populations at-risk of STI transmission.
Funding
NIHR Public Health Research Programme (17/54/06), with additional excess treatment cost support from Public Health England.
Trial Registration
ISRCTN registration: 11400820 (23/10/2019)
Ethical Review
South Central - Oxford B Research Ethics Committee REC number: 19/SC/0486 (04/11/2019); IRAS ID: 255684 (HRA approval 19/11/2019)
... The National Institutes of Health (NIH) and other agencies have thus invested substantial funds into developing digital adjunctive interventions for HIV [23•], with the hope of tapping into the promise of wide-scale delivery with high fidelity at low cost [24]. Evidence from systematic reviews and meta-analyses indicate that digital programs have significant effects on reducing HIV risk and increasing protective behaviors comparable to in-person programs [25 ••, [26][27][28][29][30][31]. Agencies like the U.S. Community Preventive Services Task Force [32], United Nations Programme on HIV/AIDS, and World Health Organization [33] have issued recommendations for digital HIV interventions. ...
Purpose of Review
Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions.
Recent Findings
We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement.
Summary
Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain “on the shelf” absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.
... Para hacer avanzar este enfoque de las redes sociales entre pares, las revisiones sistemáticas destacan que sería útil aplicar algunos enfoques generales de mejores prácticas en el campo de la EIS, como el codiseño de las intervenciones con los/as adolescentes y el uso de enfoques basados en la teoría del cambio para el diseño y la evaluación de las intervenciones. 38, 57 Una evaluación del proceso de un único estudio sobre FaceSpace recomendó sobre la importancia de contar con los recursos adecuados para desarrollar plataformas de redes sociales y mantener un alto perfil, alcance y compromiso con los/as adolescentes. 70,71 ...
... Online vignette studies may increase accessibility for participants, but current research largely overlooks accessibility considerations. With increasing use of online methods [65], it is unsurprising that many studies have delivered video vignettes online [11,20,56,66]. However, many vignette studies fail to report the study setting (the viewing location and its arrangement -for example, whether participants participated entirely online by watching vignettes on their own devices, or whether they attended an in-person viewing). ...
... Although online technologies can widen participation in research, they can also create barriers to participation by favouring those with good digital literacy and access [65,68,69]. Similarly, although social media recruitment enrolment may be effective, consideration of representation is needed: evidence suggests that social media recruitment might yield a less demographically diverse sample [70]. ...
Background
Studying clinician-patient communication can be challenging, particularly when research seeks to explore cause-and-effect relationships. Video vignettes – hypothetical yet realistic scenarios – offer advantages to traditional observational approaches by enabling standardisation and manipulation of a clinician-patient encounter for assessment by participants. While published guidelines outline stages to create valid video vignette studies, constructing high quality vignettes which are accessible to a wide range of participants and feasible to produce within time and budget restraints remains challenging. Here, we outline our methods in creating valid video vignettes to study the communication of diagnostic uncertainty. We aim to provide practically useful recommendations for future researchers, and to prompt further reflection on accessibility issues in video vignette methodology.
Methods
We produced four video vignettes for use in an online study examining the communication of diagnostic uncertainty. We followed established guidelines for vignette production, with specific consideration of how these might be applied pragmatically to save time and resources. Scripts were pilot-tested with 15 laypeople, and videos with 14 laypeople; pilot-testing involved both quantitative and qualitative analysis.
Results and discussion
We demonstrate the usefulness of existing guidelines, while also determining that vignette production need not necessarily be expensive or time-consuming to be valid. Our vignettes were filmed using an iPhone camera, and featured a physician rather than a professional actor; nonetheless, pilot-testing found them to be internally and externally valid for experimental use. We thus propose that if care is taken in initial script development and if pragmatic choices are made regarding filming techniques and pilot-testing, researchers can produce valid vignettes within reasonable time and budget restraints. We also suggest that existing research fails to critically examine the potential benefits and harms of online video vignette methodology, and propose that further research should consider how it can be adapted to be inclusive of those from underserved backgrounds.
Conclusions
Researchers creating video vignette studies can adapt the video vignette development process to suit time and budget constraints, and to make best use of available technology. Online methods may be harnessed to increase participant accessibility, but future research should explore more inclusive vignette design.
... Moreover, none centered specifically on the understudied LGBTQ+ population. Although recent systematic reviews demonstrate the efficacy of digital technologies for LGBTQ+ adults, they concentrated primarily on physical conditions like HIV prevention and sexual behaviors rather than mental health interventions for LGBTQ+ youth in particular (Bailey et al., 2015;Wadham et al., 2019;Gilbey et al., 2020). Evidence summarizing the use of digital technologies for mental health improvement among LGBTQ+ youth specifically is still exiguous, and the overall effectiveness of these innovations is also unclear despite recent surges in digital tools for this demographic. ...
LGBTQ+ youth experience mental health disparities and higher rates of mental disorders due to barriers to accessing care, including insufficient services and the anticipated stigma of revealing their identities. This systematic review incorporated 15 empirical studies on digital interventions’ impact on LGBTQ+ youth mental health, examining their potential to address these inequities. This study innovatively categorized existing digital interventions into four streams: Structured Formal (telehealth, online programs), Structured Informal (serious games), Unstructured Formal (mobile applications), and Unstructured Informal (social media). We found that S&F and U&F effectively reduced symptoms. U&F showed potential but required enhancement, while U&I fostered resilience but posed risks. Further integration of emerging technologies like virtual reality may strengthen these interventions. This review identifies the characteristics of effective digital health interventions and evaluates the overall potential of digital technologies in improving LGBTQ+ youth mental health, uniquely contributing insights on digital solutions advancing LGBTQ+ youth mental healthcare.
... This includes studies of the impacts of COVID-19 on health outcomes [11,12]. Along with focusing on health safety, digital studies facilitate recruitment of large sample of participants, especially those that live in rural areas [13]. They also reduce the cost and participant burden for collecting multiple waves of data over a short time period. ...
Background:
Amidst the COVID-19 pandemic, there has been growing concern about the declining mental health and healthy behaviors compared to pre-pandemic levels. Despite this, there is a lack of longitudinal studies that have examined the relationship between health behaviors and mental health during the pandemic. In response, the statewide COVIDsmart longitudinal study was launched. The study's main objective is to better understand the effects of the pandemic on mental health. Findings may provide a foundation for the identification of public health strategies to mitigate future negative impacts of the pandemic.
Methods:
Following online recruitment in spring of 2021, adults, ages 18 to 87, filled out social, mental, economic, occupational, and physical health questionnaires on the digital COVIDsmart platform at baseline and through six monthly follow-ups. Changes in the participant's four health behaviors (e.g., tobacco and alcohol consumption, physical activity, and social media use), along with sex, age, loneliness score, and reported social and economic (SE) hardships, were analyzed for within-between group associations with depression and anxiety scores using Mixed Models Repeated Measures.
Results:
In this study, of the 669 individuals who reported, the within-between group analysis indicated that younger adults (F = 23.81, p < 0.0001), loneliness (F = 234.60, p < 0.0001), SE hardships (F = 31.25, p < 0.0001), increased tobacco use (F = 3.05, p = 0.036), decreased physical activity (F = 6.88, p = 0.0002), and both positive and negative changes in social media use (F = 7.22, p = 0.0001) were significantly associated with worse depression scores. Additionally, females (F = 6.01, p = 0.015), younger adults (F = 32.30, p < 0.0001), loneliness (F = 154.59, p < 0.0001), SE hardships (F = 22.13, p < 0.0001), increased tobacco use (F = 4.87, p = 0.004), and both positive and negative changes in social media use (F = 3.51, p = 0.016) were significantly associated with worse anxiety scores. However, no significant changes were observed in the within-between group measurements of depression and anxiety scores over time (p > 0.05). Physical activity was not associated with anxiety nor was alcohol consumption with both depression and anxiety (p > 0.05).
Conclusions:
This study demonstrates the longitudinal changes in behaviors within the context of the COVID-19 pandemic. These findings may facilitate the design of preventative population-based health approaches during the COVID-19 pandemic or future pandemics.
... This is similar to findings from prior research using web-based tools to provide reproductive health education in adolescent populations. [17][18][19] Yet, this is a novel and significant contribution because this is the first structured program addressing SCD-specific considerations regarding genetic transmission, contraception, and fertility for male AYAs with SCD and their caregivers. 17,20 FUTURES was also highly acceptable, as demonstrated by high recruitment rates and satisfaction ratings, in alignment with previous research showing interest in this topic among AYAs with SCD. ...
... In countries such as the UK, young people are often considered a particularly hard-to-reach group in relation to effective sexual health service delivery [4]. Outreach services that aim to make sexual health services more accessible for this age group do exist, but provision and uptake is variable [5]. ...
Background
Sexual health is fundamental to the overall health and wellbeing of individuals and to the social and economic development of communities and countries. However, internationally young people endure a disproportionate burden of sexually transmitted infections and unintended pregnancies which can be associated with poor psycho-social outcomes. Digital sexual health interventions have been developed to increase young people’s access to sexual health services, but are currently underutilised.
Aim
This systematic review sought to identify the barriers and facilitators to young people’s engagement with bidirectional digital sexual health interventions, which are standalone two-way tailored interventions between a young person and healthcare professional.
Methods
The review was conducted in accordance with the JBI methodology for mixed methods systematic reviews, following a convergent integrated approach to synthesis and integration of qualitative and quantitative evidence. Searches of ten electronic databases were conducted, spanning database inception to January 2022. No restrictions were imposed on language, geographical location or community setting. All included studies were critically appraised with JBI Critical Appraisal tools. Data extraction was performed using standardised tools, followed by data transformation. Data synthesis followed the convergent integrated approach. Each stage was conducted by two independent reviewers.
Results
Eight thousand four hundred thirty-nine titles and abstracts and, subsequently, 255 full-texts underwent review. Nine studies were selected for inclusion with no studies added following forward and backward citation tracking. The included studies comprised three qualitative and six quantitative designs. Three meta synthesised findings were identified: (1) The design of a digital intervention for adolescent sexual health needs to reflect the end users’ specific needs (2) Young people need to feel comfortable when using a digital sexual health intervention (3) Potential barriers to engagement need to be addressed. The review identified that although barriers and facilitators to promoting young people’s engagement with bidirectional digital sexual health interventions are nuanced, young people’s privacy and security need to be prioritised for them to engage with digital interventions, regardless of the platform of choice.
Conclusions
Co-production of digital sexual health services, in partnership with young people, has shaped many of the insights reported in this systematic review. Further international research which places an emphasis on young people’s perspectives is vital to unleash the full potential of digital technology in this domain.
... There is a wealth of information on the design and implementation of Internet and digital interventions [9][10][11][12], with a wide variety of designs, content and functions. Interventions, in their media and functionalities, are developing, for example, dedicated platforms, the use of SMS or instant messaging, the use of webisodes of media series, the use of online social networks or live chat [13]. ...
... Internet and digital interventions have been on the scene for several years now, starting with the simple online transmission of information, making it difficult to find and sort reliable and valid information [5]. Over time, and with the evolution of digital technology, many existing interventions have taken advantage of these tools to promote social interaction and participation in sexuality education, in line with young people's expectations [11,12,14]. Today's digital features make it easy for young people to interact and participate in sexuality education [9]. ...
Background
Promoting sexual health is key to improving the supportive behaviors and well-being of young people. With the advent of the Internet, web-based features for sexual health promotion may be attractive to a diverse range of young people. This study aims to assess young people’s proposals regarding a web-based intervention for sexual health promotion.
Methods
Nineteen French young people aged 15–24 years participated to the study. In a semi-structured interview, they presented their views on a web-based intervention for sexual promotion. Data were coded with N’Vivo and subjected to qualitative thematic analysis to explore their proposals.
Results
The majority of participants (n = 18) thought that a web-based intervention for sexual health promotion would be attractive. Young people interviewed made 31 concrete proposals for sexual health promotion on the Internet. Participatory and interactive dimensions on the internet appeared essential, with the need for stimulating activities and interaction with peers, but also with competent professionals and moderation. Face to the risks of the internet, they expressed the need of a secure and confidential space, to generate trust and participation in intervention. For participants, sexual health should be addressed in all its dimensions, taking into account the relational, sexual, and gender dimensions, and by incrementing on the internet valid, credible and personalized content.
Conclusions
In sexual health promotion, young people are indispensable stakeholders who can make concrete proposals and can also participate in content creation and research. More broadly, in health promotion, involving target audiences in decisions represents a promising perspective.
... Previous research shows that sexual ill-health causes high social and economic costs (1)(2)(3). Sexually transmitted infections (STIs) are common globally (1,4), and the frequency of STI diagnoses has increased in the EU/EEA, especially among young people, even though prevention-focused sexual health education and programs have increased in availability (4). The preventive intervention approach has, in other words, not been sufficient in protecting and promoting the sexual health of the population. ...
... There is a need to guide adolescents in how to make informed sexual health choices, as well as to support the development of health resources that promote sexual well-being and resilience in dealing with risks related to sexual health. Sexual health promotion interventions form a key public health strategy to meet these needs (4)(5)(6), and more effective, costeffective as well as engaging sexual health promotion interventions in an early stage of life are warranted (2,5,7). ...
... Moreover, the risk approach does not cover the positive sexual health content that adolescents themselves wish to learn more about (17,25,31), which is perhaps why another review study found evidence of positive intervention effects when adolescents participate in the planning and implementation of programs (8). The health promotion approach shows promising evidence of effect (2,5,32), nonetheless, the health promotion perspective regarding adolescent sexual health is still understudied (5,14,23). There is a lack of synthesized evidence on the sexual health resources that adolescents want to learn about that can promote sexual health and well-being, e.g., sexual health literacy (14), self-esteem (6), respect and social skills regarding sexuality (23). ...
Introduction
Sexual ill-health is an urgent public health issue with subsequent social and economic costs. There is, therefore, a need for more effective sexual health promotion interventions in an early stage of life. Previous research has focused on preventive sexual health interventions applying a risk perspective, and the limited and scattered evidence concerning school-based sexual health promotion interventions employing a health-resource perspective has not been compiled and synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in schools in Europe.
Method
A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and included information on study characteristics, intervention content, methods, and outcomes relevant to the current review. A narrative synthesis of the included studies was performed, highlighting the collective results.
Result
Seventeen records were included in the review, reporting on 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All three studies with a qualitative research design described positive effects experienced by the participants. Six of thirteen quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. The outcomes of interest were grouped into five areas, and most studies focused on the area of attitudes toward sexual health.
Conclusion
The findings indicate promising evidence of effect for interventions with a health promotion approach, highlighting the importance of strengthening sexual health resources related to respect, communication skills, attitudes, and other positive psycho-social aspects of sexual health. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas a comprehensive focus on the multi-dimensional sexual health literacy concept is less common and can be recommended to be included in future intervention research.
