Nursing & Community Health, School of Health 7 ife Sciences, Glasgow Caledonian University, Glasgow, UK
Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK.
Sex Transm Infect. 2021 Jun;97(4):276-281. doi: 10.1136/sextrans-2020-054869. Epub 2021 Apr 27.
1.5 million people in the UK have mild to moderate learning disabilities. STIs and bloodborne viruses (BBVs) are over-represented in people experiencing broader health inequalities, which include those with mild learning disabilities. Self-managed care, including self-sampling for STIs/BBVs, is increasingly commonplace, requiring agency and health literacy. To inform the development of a partner notification trial, we explored barriers and facilitators to correct use of an STI/BBV self-sampling pack among people with mild learning disabilities.
Using purposive and convenience sampling we conducted four interviews and five gender-specific focus groups with 25 people (13 women, 12 men) with mild learning disabilities (July-August 2018) in Scotland. We balanced deductive and inductive thematic analyses of audio transcripts to explore issues associated with barriers and facilitators to correct use of the pack.
All participants found at least one element of the pack challenging or impossible, but welcomed the opportunity to undertake sexual health screening without attending a clinic and welcomed the inclusion of condoms. Reported barriers to correct use included perceived overly complex STI/BBV information and instructions, feeling overwhelmed and the manual dexterity required for blood sampling. Many women struggled interpreting anatomical diagrams depicting vulvovaginal self-swabbing. Facilitators included pre-existing STI/BBV knowledge, familiarity with self-management, good social support and knowing that the service afforded privacy.
In the first study to explore the usability of self-sampling packs for STI/BBV in people with learning disabilities, participants found it challenging to use the pack. Limiting information to the minimum required to inform decision-making, 'easy read' formats, simple language, large font sizes and simpler diagrams could improve acceptability. However, some people will remain unable to engage with self-sampling at all. To avoid widening health inequalities, face-to-face options should continue to be provided for those unable or unwilling to engage with self-managed care.
英国有 150 万人患有轻度至中度学习障碍。性传播感染（STIs）和血源性病原体（BBVs）在经历更广泛健康不平等的人群中更为常见，其中包括那些患有轻度学习障碍的人。自我管理护理，包括自我 STI/BBV 采样，越来越普遍，需要机构和健康素养。为了为伙伴通知试验的开展提供信息，我们探讨了轻度学习障碍者正确使用 STI/BBV 自我采样包的障碍和促进因素。
使用目的性和便利性抽样，我们在 2018 年 7 月至 8 月在苏格兰对 25 名（13 名女性，12 名男性）轻度学习障碍者进行了 4 次访谈和 5 次性别特定焦点小组讨论。我们对音频记录进行了演绎和归纳主题分析，以探讨与正确使用套件相关的障碍和促进因素。
所有参与者都发现套件的至少一个元素具有挑战性或不可能，但他们欢迎有机会在不前往诊所的情况下进行性健康筛查，并欢迎包含避孕套。正确使用的障碍包括感知到的过于复杂的 STI/BBV 信息和说明、感到不知所措以及采血所需的手的灵巧度。许多女性在解释描绘阴道自我采样的解剖图时遇到困难。促进因素包括现有的 STI/BBV 知识、对自我管理的熟悉程度、良好的社会支持以及知道该服务提供隐私。
在第一项探索学习障碍者使用 STI/BBV 自我采样包的可用性的研究中，参与者发现该套件难以使用。将信息限制在告知决策所需的最低限度、“易读”格式、简单语言、大字体大小和更简单的图表可以提高可接受性。然而，有些人仍然无法参与自我采样。为了避免扩大健康不平等，对于那些无法或不愿意参与自我管理护理的人，应该继续提供面对面的选择。
