Sexual health impacts on young people’s lives
Young people’s sexual health plays an important role in their physical health as well as their emotional and social wellbeing. Sexual ill health affects young people more than any other age group and they are more likely to experience sexually transmitted infections (STIs) and unplanned pregnancies. Men who have sex with men and those in care or who use drugs are particularly vulnerable. Providing young people with accessible and trustworthy sources of information is therefore important not only for their sexual health but for their overall wellbeing.
However, engaging young people with sexual health promotion can be challenging. The quality of school sex and relationships education in the UK is very varied and discussing sexual matters in person can be difficult and embarrassing. Finding the sexual health information they want or accessing services, such as clinics, can also be difficult.
One new and potentially useful approach to reach young people is through digital media. Mobile phone and internet access is widely available and integral to young people’s day-to-day lives, so using tailored interactive digital interventions (IDIs) could be an effective way of delivering sexual health promotion.
With funding from the NIHR Public Health Research Programme, a team of researchers led by Dr Julia Bailey at UCL carried out a scoping study to investigate the role of IDIs in promoting sexual health for young people. Explaining the aim of their study, Dr Bailey, an associate professor in Primary Care at the UCL eHealth Unit, said:
Digital media can be an important health communication channel, and it is important to know how to make best use of technologies such as mobile phone and the internet for sexual health promotion.
Dr Bailey continued: “In this project, we collected evidence about whether digital interventions work, and how to design them and make them available in schools, clinics and online.”
The study’s results have been published in Public Health Research.
Making IDIs accessible to young people
The scoping review focused on whether IDIs that promoted sexual health to young people aged 13–24 years could teach users useful information or influence changes in sexual behaviour.
The team reviewed all types of research evidence relating to digital technology, looking in particular at IDIs for self-guided use, as these were likely to reach the most users directly and at a low cost. This included analysing the results of randomised controlled trials (RCTs) and gathering opinions on sexual health promotion from young people, parents and experts in the field of digital media and sexual health through focus groups, online discussion forums and workshops.
The review showed that IDIs taught sexual health facts effectively and could be as successful as teacher-delivered lessons for learning information. IDIs also had a small influence on young people’s confidence and sexual behaviour, such as using condoms for safer sex.
Online interventions can offer convenient and private access to sexual health information that can be difficult or embarrassing to discuss in person. Dr Bailey’s team also found that an IDI’s success depended on how easily young people could access it and where they received the intervention. For example, IDIs delivered by school teachers or healthcare professionals at a clinic could be helpful as young people are more likely to fully engage with them.
Several obstacles to delivering IDIs in the schools and clinics were identified, such as cost, access to IT and difficulties providing IDIs alongside staff’s existing teaching or care commitments. There was little evidence on the cost of delivering IDIs but the researchers suggested they could be cost-effective in groups of young people vulnerable to STIs.
The future for digital media in sexual health promotion
Dr Bailey’s team showed how IDIs can play a useful role in sexual health education in schools, in clinical settings and online, and how they could offer young people (including the more vulnerable) access to reliable, private, tailored and supportive sexual health information. In the context of Covid-19 and increasing pressure on health services and budgets, and the enthusiasm of young people to engage with online health resources, IDIs could offer low-cost and widespread sex and relationships education.
Since its publication, evidence from the review has helped advise healthcare providers and commissioners planning to integrate digital media with face-to-face health services. It has influenced a national stakeholder consultation event for regional Public Health England Centres, as well as national consultations with Scottish and Welsh policymakers, commissioners and clinicians.
The study’s evidence has also been used to develop the Contraception Choices website, which combines user views, research evidence and clinical expertise to offer tailored advice for contraception decision-making. The website is accessible from NHS online information pages and attracts 22,000 visits a month.
Dr Zara Haider, Consultant in Sexual and Reproductive Health at Kingston Hospital, said:
We recommend the Contraception Choices website to our patients to help inform their contraception decisions and to reinforce information given during consultation. The infographics and content are of excellent quality and allow the patient to easily understand the merits or potential drawbacks of the various contraceptive methods.
An RCT funded and published by the NIHR Health Technology Assessment Programme, and a qualitative evaluation published in Digital Health, found that young women appreciated the clear, straightforward information on the Contraception Choices website, as well as the interactive infographics and personalised side-by-side contraceptive method comparisons (What’s right for me?). Feedback showed that the website helped women learn new information, make decisions about contraception and prompted discussions with partners, friends and healthcare practitioners.
It has made me feel more confident. Prior I didn't really have anyone to speak to about contraception and I didn't feel comfortable discussing it with my doctors so this bridged the gap.
User of the Contraception Choices website
Other areas of impact have included a collaboration with the charity Avert to hold a workshop with stakeholders in Zimbabwe, Zambia, Malawi and Mozambique to design a digital intervention for sexual health for sex workers in Southern Africa. The principles of engaging, evidence-based digital intervention design are also feeding into an update of the Sextherapylondon website for sexual difficulties, and underpin recommendations for a digital intervention for contraception in Botswana.
The scoping review has also influenced the training of practitioners to signpost patients to sexual health online, offering websites and apps for health promotion and risk reduction before, during and after consultations.
Dr Bailey’s research team has since conducted three more systematic reviews to assess the evidence for IDIs in sexual health promotion and support the implementation of IDIs for HIV prevention for adults as well as young people. The team’s review of interactive digital interventions for prevention of sexually transmitted HIV found good evidence that IDIs can increase knowledge, intention and HIV prevention behaviours. The team’s research into HIV prevention in sub-Saharan Africa found that IDIs helped people manage their HIV by adhering to their HIV medication. They also found that IDIs are effective for women with sexual difficulties.