Wrapped: Development and specification of an intervention to increase condom use amongst young people accessing chlamydia self-testing websites

Rationale: In England, the Department of Health has made reducing the rates of Sexually Transmitted Infections (STIs) a priority, particularly amongst young people who are disproportionately affected. The best way for sexually active people to avoid STIs is to use a condom but young people report inconsistent use. A missed opportunity to intervene to increase condom use is when they access self-testing kits for STIs via the internet. On average 130,000 young people are tested via this route every year in England. Those tested are at high risk of future STIs and include groups which other services have found difficult to engage, such as young men and those from deprived backgrounds. Typically however, these websites provide little or no sexual health promotion. Aims: This study aimed to develop a theory-based, tailored intervention to increase condom use for young people aged 15-24 years accessing chlamydia self-testing websites. Methodology: The intervention (Wrapped) was co-designed with young people to maximise future appeal and use by the target audience. Development followed guidance from the Medical Research Council (MRC) on developing complex behaviour change interventions. The following steps were performed: 1) identification of important determinants of condom use and evidence of their ‘changeability’ using computer/digital interventions, 2) identification of suitable Behaviour Change Techniques (BCTs), and engaging methods of delivery, to target these determinants , 3) design of the tailored intervention ensuring fidelity to theoretical basis and high levels of appeal/usability. Analysis: Not applicableResults: The resulting intervention is to be embedded within existing chlamydia self-testing websites as part of the user pathway. It uses a ‘recommender system’ to identify users’ salient barriers to condom use and to present relevant components of the intervention to target these. Components are delivered over a period of days in between the request for a chlamydia self-testing kit and provision of the result. The components include: provision of a selection of condoms/lubricant and instructions for identifying preferred type(s), easy access to preferred condom(s)/lubricant through a discrete delivery service, video demonstration of eroticized condom application, real sex videos showing condom use, talking heads of other young people discussing how to communicate wish to use condoms, and provision of condom storage/carrying product. Conclusions: this tailored intervention will be directed at young people who may be particularly receptive to messages and support for behaviour change due to their testing status. The content of this intervention makes a deliberate attempt to target cognitive processes relating to both system one (emotional, instinctive, responds to needs – basic urges and drives) and two (analytical, controlled, rational, can plan ahead). Next steps are to run a feasibility study and then a full trial of the intervention to establish its efficacy.