Modernising UK sexual health services with SH:24

Background

When we first sat down with the SH:24 team, they told us that sexual health services were in crisis. Budgets were being cut which meant vital local clinics were reducing hours or even closing. Rates of sexually transmitted infections (STIs) like chlamydia, gonorrhea and syphilis were rising, particularly among young people. If someone wanted to get a test, they might have to stand outside a clinic for hours with no guarantee that they’d be seen that day. Not many people want to be seen outside an STI clinic or risk taking time off work if they can’t even get an appointment.

Sexual health was also still a taboo subject. People felt uncomfortable talking about their symptoms or their sex life. Some people were worried about partners, friends or parents finding out so didn’t want to risk being seen at a clinic. Others were concerned about prejudice and homophobia with a perception that sexual infection is negatively associated with gay communities.

All of this meant that people weren’t getting tested for infections that are mostly easy to treat. If they don’t get tested but do have an infection, there’s a good chance they’ll pass that infection on. So the rates continue to rise.

At the time, there were no online services available delivering comprehensive STI testing, free at the point of care. People were becoming increasingly used to accessing other everyday services online, such as banking, shopping or travel booking. It seemed there was a big opportunity to develop a new service that worked around the needs of its users.

Our approach

We took a minimum viable product (MVP) approach to build a public-facing website and back-office management system with automated result processing.

We started with a few open questions:

We set out a series of assumptions to test with users. This meant we needed to find out more about what users think, feel and do when dealing with their sexual health. We used methodology from lean and agile - that meant that we focused on testing quickly, getting rid of things that didn’t work and learning by trying things out. We used sketches and basic prototypes to learn as much as we could before investing time in building a feature.

We set up a base close to the clinic so we could spend time with patients in clinic waiting rooms. We showed them sketches of the online order journey and allowed them to add notes or make changes. Through this collaboration, we learnt a lot about user expectations of the service.

For example, we wanted to know if people were happy to receive their results by text message.

By sending example messages to users we found out that most people preferred text message. However they didn’t want the text to state what the test was for in case someone else saw it. They wanted it to be discreet and from an unnamed number. If their test showed they might have HIV they preferred a phone call from a clinician at a time that suited them, when they could find a quiet, private place to speak.

We also wanted to find out if people wanted an online account. They didn’t. At the time, most people found online accounts cumbersome with complicated log in processes. They didn’t see any value in logging in for their results. However, some years later, SH:24 did further research and found that, as digital technology has developed and people are more used to have accounts for everything, there is now a demand for online accounts. So it’s important to keep checking in on these assumptions as technology and user behaviour changes.

We then started testing some prototypes with a basic order journey and test kits sent out to a small group of users. We used GOV.UK design patterns to build a working prototype quickly.

We wanted to understand how to ask the right questions in the order form to help users work out what test kit they needed - SH:24 didn’t expect users to have to work this out for themselves. But people describe symptoms in different ways. They don’t always tell the truth about who they have sex with and they might not feel comfortable asking questions about their genitals. We worked closely with a content designer to find language that reassured people and gave them the confidence to use the service whenever they needed it.

The sight of blood

One of the things we learnt at this point was that people found it hard to take a blood sample. We’d thought we could offer online instructions, but testing showed us that trying to unlock a phone with blood dripping from your finger was not a good experience.

We then developed a short video that users could watch in advance. It showed them how to warm up their arm and use a small lancet to prick their finger then angle it in the right way to drop blood into the sample tube. We showed this video to users in clinic - and here comes a big learning point - some people hate the sight of blood.

One user even closed the laptop.

They were already worried about using a lancet to prick their finger - why would they want to see more blood?

This is why user testing is so important - we learnt very quickly that simple paper instructions would be the most effective way to support people. We still made a video but it doesn’t show so much blood.

The outcome

Our focus on engaging a complex set of stakeholders, from clinicians and service users to clinic receptionists, helped us deliver better outcomes and rapid adoption of the services.

Users can now order STI test kits, contraception and treatment online, 24/7, with results and updates by text and specialist clinical support from their in-house nursing team. Local clinics can fast track treatment and clinicians can manage results and respond to queries within a secure system.

What we learnt

Going to where users are was vital. By taking our prototypes into waiting rooms and consultations we could quickly test a basic version of the end to end service with all users (including clinic staff), making cost efficient improvements quickly.

An MVP approach helped us demonstrate value and get buy-in from clinicians who were used to a more traditional approach to evaluating new concepts. This enabled them to make confident decisions about what to build.

It’s this kind of learning that we’ve distilled into our Digital Accelerator. We combine research and rapid prototyping to bring your team and wider organisation together around a shared vision. By engaging your customers in development of your proposed product or service and unpacking the constraints and opportunities in the current market, we’ll get you ready to deliver with confidence.

Beyond the project

Our work gave SH:24 a platform to scale up across the UK and internationally, adding new services to meet a wide range of sexual and reproductive health needs with the same technology. This collaborative, digital innovation has helped to transform the whole sector and show how technology can shape the future of healthcare when designed with and for service users.

As a start up, SH:24 had extensive clinical experience but no digital team. We helped them to build an in-house team and embed an agile, user-centred approach that complemented their core values. They’ve since carried out extensive research and published multiple academic papers about the role of digital, human-centred services in improving access to sexual and reproductive healthcare.