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The acceptability and feasibility of implementing a bio-behavioural enhanced surveillance tool for sexually transmitted infections in England: a mixed methods study

Publication date: 

2018-05-04 00:00:00


JMIR Public Health Surveill 2018 vol.4. iss 2. e52 p.1


Sonali Wayal, David Reid, Paula Blomquist, Peter Weatherburn, Catherine H. Mercer*, Gwenda Hughes* (*joint senior authors)

Publication type: 



Background: Sexually transmitted infection (STI) surveillance is vital for tracking the scale and pattern of epidemics; however, it often lacks data on the underlying drivers of STIs. Objective: We assessed the acceptability and feasibility of implementing a bio-behavioural enhanced surveillance tool (BBEST), comprising of a self-administered online survey among sexual health clinic (SHC) attendees, and linking this to their electronic patient records (EPR) held in England’s national STI surveillance system. Methods: Staff from 19 purposively selected SHCs across England, and men who have sex with men (MSM) and black Caribbeans, due to high STI burden among these groups, were interviewed to assess the acceptability of the proposed BBEST model. Subsequently, SHC staff invited all attendees to complete an online survey on drivers of STI risk using a study tablet or participants’ own digital device. They recorded the numbers of attendees invited and participants’ clinic numbers, which were used to link survey data to the EPR. Participants’ online consent was obtained, separately for survey participation and linkage. In post-implementation phase, SHC staff were re-interviewed to assess the feasibility of implementing BBEST. Acceptability and feasibility of implementing BBEST were assessed by analysing these qualitative and quantitative data. Results: Pre-BBEST implementation, SHC staff and attendees emphasised the importance of free internet/wifi access, confidentiality and anonymity for increasing the acceptability of BBEST among attendees. Implementation of BBEST across SHCs varied considerably and was influenced by SHCs’ culture of prioritisation of research and innovation, and availability of resources for implementing the surveys. Of 7367 attendees invited, 85.3% agreed to participate. Of these 6283, 73.0% logged into the survey; 70.6% (n=4437) were eligible and completed it. Of these, 91.2% (n=4,046) consented to EPR linkage, which did not differ by age or gender but was higher among MSM than heterosexual men (95.5% vs. 88.4%; P<0.01), and lower among Black Caribbean than white participants (87.1% vs 93.8%; P <0.01). Linkage was achieved for 88.9% of consenting participants. Conclusions: Implementing the BBEST in SHCs was feasible and acceptable to staff and groups at STI risk; however ensuring participants’ confidentiality and anonymity, and availability of resources is vital. BBEST could enable timely collection of detailed behavioural data for effective commissioning of sexual health services.