Frontiers in Public Health (Oct 2015)
Implementation of digital interventions for sexual health for young people
Abstract
Background Young people are at risk of poor sexual health and are in need of comprehensive, effective sexual health education. Young people are confident users of digital technology such as the Internet and mobile phones, and there are many innovative possibilities for sexual health education. Sexual health promotion IDIs have been shown to be effective in improving knowledge and intention. However significant impact will only be achieved by maximising their Reach (proportion of the target population reached), Adoption (within the target setting) Implementation (how well it is delivered) and Maintenance (sustainability) (RE-AIM). Aims To synthesise the evidence on the barriers and facilitators to the implementation of digital interventions for sexual health promotion for young people Methods We conducted a scoping review of evidence on digital interventions for sexual health promotion for young people aged 13 to 24 years in the UK, defining sexual health in holistic terms, to include physical, emotional, mental and social well-being in relation to sexuality. Interactive digital interventions (IDI) are defined as digital media programmes that provide sexual health information and tailored decision support, behaviour-change support, and/or emotional support for sexual health issues. We conducted a thorough review of literature to locate and synthesise available evidence on digital interventions for sexual health spanning the last ten years, integrating the findings with the views of key informants (young people, parents, and experts in digital media/sexual health). Results and conclusions There were few studies that assess the factors related to successful implementation of sexual health promotion IDIs. Potential barriers and facilitators to implementation of IDI should be addressed at the very beginning of an intervention development process. Engaging with sexual health promotion interventions online allows private and convenient access as well as potentially reaching populations who engage less frequently with mainstream services. However, it is difficult to ensure that users will find the intervention, or engage for long enough for them to be effective. The reach of online IDI could be enhanced by linking sexual health promotion interventions with existing digital systems such as STI self-test websites, or with trusted branded websites or popular social networking sites. Offering interventions in static settings such as the clinic or classroom encourages engagement and enables interventions to be delivered with fidelity but potentially at the expense of the privacy and convenience offered by online interventions. Using the knowledge of local staff is vital for both successful intervention development and successful implementation. An effective intervention usually requires some adaptation for local contexts, but care is needed to identify and preserve the core components so that effectiveness is maintained. Technical support, moderation/monitoring and updating are further challenges for implementing sustainable digital interventions. Facilitated engagement (e.g. with teachers or clinicians) could encourage young people to access interventions and may be more likely to facilitate engagement. There is great enthusiasm for digital health interventions for health at national policy level in the UK, and many local initiatives, but few national policy levers to drive implementation of sexual health promotion IDIs in practice. Responsibility for sexual health is now increasingly devolved to local healthcare and local authority commissioning groups, meaning that national initiatives are difficult. Collaboration is needed between users, developers, researchers and local and national stakeholders.
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