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Iyamu, Ihoghosa

University of British Columbia

Background: Using GetCheckedOnline – British Columbia’s (BC) digital intervention for sexually transmitted and blood-borne infections (STBBI) testing, this dissertation contributes knowledge to reduce disparities in uptake of digital STBBI testing services by identifying web design and implementation factors influencing their utilization. Methods: This dissertation includes; 1) a scoping review of health equity impacts of digital STBBI testing interventions; 2) interrupted time series analyses of program data evaluating the COVID-19 pandemic’s impact on GetCheckedOnline’s long-term utilization trends; 3) analyses of the 2022 GetCheckedOnline client survey data to identify web design and implementation factors associated with missed opportunities to provide testing (i.e., self-reported inability to test despite needing testing at account creation); and 4) an interpretive description of experiences and expectations of GetCheckedOnline’s web and implementation among users experiencing missed opportunities. Results: The scoping review found only 3/27 included articles used methods allowing exploration of health equity impacts of digital STBBI testing. While increasing STBBI testing across sociodemographic strata, uptake of these interventions occurs along existing sociodemographic gradients, being higher among white, urban residents, and women with higher socioeconomic status. Interrupted time series analyses revealed significantly higher trends in GetCheckedOnline’s utilization after 19 months of the pandemic, especially among people 40 years or older, men who have sex with men, racialized minority populations and first-time testers. The GetCheckedOnline client survey revealed 32% of users experienced missed opportunities. Web design factors including ease of website use, and implementation factors like difficulty accessing a laboratory, perceived inadequacy of STBBI tests on GetCheckedOnline and preference for self-sampling were associated with missed opportunities. Interviews suggested transitioning between GetCheckedOnline, and partner laboratory services is a major barrier, users’ appraisal of their health and social contexts is a determinant of testing, and users believe tailoring GetCheckedOnline’s web and implementation to varying user needs can promote equity. Conclusions: Digital STBBI testing interventions may reinforce inequitable STBBI testing with current designs. While GetCheckedOnline has become increasingly relevant especially for historically marginalized groups since the pandemic, easing the transition between the website and partner laboratory services, and adapting implementation options to user contexts including self-sampling can promote equitable digital STBBI testing.

Text

2025-05-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88364

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/