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Summary of Proposal Click to edit Master subtitle style

Advancing Health Equity in Online Sexual Health Services Gay Men’s Health Summit 2011 November 3, 2011

Janine Farrell, Simon Fraser University Travis Salway Hottes, BC Centre for Disease Control

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Acknowledgements

•  Mark Gilbert, Online Services Lead •  Devon Haag, Online Services Program Manager •  Mark Bondyra, Business Analyst, Online Services •  Internet Services Committee & Working Groups,

BC Centre for Disease Control •  Jeannie Shoveller and colleagues, UBC Youth Sexual

Health Team •  Community and health authority partners

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Outline

•  GetCheckedBC and the BC Online Sexual Health Services Program

•  Theory of Fundamental Causes •  Health equity impact assessment (HEIA) •  Application of HEIA to GetCheckedBC

§  Primary findings §  Recommendations and actions

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Online Sexual Health Services

•  Using online and other new technologies to: §  Deliver innovative sexual health services §  Reduce barriers to accessing appropriate sexual health care §  Reduce overall burden of STI in BC

“Across the spectrum of sexual health care” Integrated with clinical services

Clients accessing online services

Clients accessing

clinic services

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GetCheckedBC

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Rationale

•  Reduce barriers to accessing testing •  Improve test uptake and frequency in high prevalence

populations •  Reduce burden on in-person sexual health services

(clinics) •  Respond to shifting expectations for client-centered care

… building on successful pilot programs elsewhere.

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Key Concerns

•  Anonymity à limit collection of personal information

•  Data security à secure web-browsing, remind clients to clear cache/history

•  Pre-test discussion à detailed information on website, referrals to in-person care, where helpful

•  Provision of test results à no positive results online, links and referrals to counseling, support, community services, etc.

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Timelines and Priority Groups 2009 - 2010 •  Public health •  Community partner organizations •  End users (focus groups, usability testing of prototype)

2012 - 2013 •  GetCheckedBC piloted at 2 BCCDC Clinics •  Targeted promotion to gay men in Vancouver

2010 - 2011 •  Ongoing consultation •  Privacy and technical assessments •  HEIA and other formative evaluation work

2013 - 2014 •  Upon successful completion of pilot, expansion to other sites

throughout province

Establish Collaborations

Planning & Development

Phase I: Pilot & Evaluation

Phase II: Broader

Implementation

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Online Services and Health Equity

•  Advancements in technology provide many opportunities to improve health access

•  However, introducing new health technologies does not guarantee improved health access

•  In fact, they may reinforce social inequities in health, for some.

Why?

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Theory of Fundamental Causes •  Flexible resources à allow people to avoid/mitigate effects of

disease through access to health technologies

•  Wealth, knowledge, skills, education, power, prestige, social capital

•  Regardless of historical period, geographical area, disease, etc.

•  Most salient with health outcomes that are preventable

•  Novel health technologies can create new gradients in health distribution that did not exist before

(Link & Phelan, 1995; Link, Phelan & Tehranifir 2011)

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Theory of Fundamental Causes

•  New technologies often replace old ones and tend to reinforce the same barriers and gradients in health status

•  é complex intervention = é resources required to benefit =

é likely to reinforce social inequities

(Link & Phelan, 1995; Link, Phelan & Tehranifir 2011)

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GetCheckedBC HEIA §  Will GetCheckedBC have differential impacts on certain

populations when it is scaled up across the province?

§  Are the impacts unnecessary, avoidable, inequitable?

•  Goals:

1.  Incorporate health equity

2.  Enhance potential benefits

3.  Mitigate or reduce negative

4.  Avoid reinforcing health inequities

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Health Equity Impact Assessment

1.  Screening

2.  Scoping

3.  Impact Assessment •  Literature Review

•  Online services immersion

4.  Monitoring

5.  Evaluation Must be completed after program implementation

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Findings

•  Potential missed infection (Harm)

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Recommendations and Next Steps

•  Add pharyngeal/rectal swabs and Hepatitis C testing "

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Findings

•  High expected uptake in priority populations (benefit)

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Findings

•  GetCheckedBC may not reach beyond people who already have adequate access to testing (reinforce inequity)

§  Service may not translate to non-urban, non-Vancouver geographical areas (reinforce inequities)

§  Multiple barriers to testing and health access exist for individuals and populations (reinforce inequity)

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Recommendations and Next Steps •  Prioritize health equity as a program goal"

§  Develop capacity and skills related to health equity in team members"

§  Treat health equity as an ongoing process and program goal"

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Recommendations and Next Steps

•  Integrate measures of health equity in Phase I data collection and analysis plan"§  Go beyond traditional ‘risk groups’ "

•  e.g. fracture the category of ‘MSM’"

•  Collect data on the social determinants of health "

§  Include equity measures and outcomes in Phase I evaluation plan and analysis."

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Recommendations and Next Steps

•  Provincial Scale-up (Phase II)"§  Revisit 2011 HEIA"

§  Repeat HEIA"

§  Employ community based modes of formative research to inform scale up"

§  Usability testing and focus groups beyond initial (Phase I) priority populations "

§  Consider tailoring program for populations most in need of this service"

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Findings •  Content of site may exclude underserved and

stigmatized populations (reinforce inequity) – e.g. of ‘stock images’, language

Source: blog.poz.com

•  Targeted promotion of service may reinforce limited ideas about about ‘who should test’ (reinforce inequity)

≠

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Findings

•  Youth have unique barriers (reinforce inequity)

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Recommendations and Next Steps

•  Prioritize program sensitivity and make it usable for everyone!

§  Avoid •  normative language, images, themes

•  inaccessible language

•  overly complex and/or unnecessary background information

§  Overall testing process should be as simple as possible

§  Use non-text based information (video, audio, pictures/diagrams)

The Health Equity Assessment Tool: A User’s Guide produced by the New Zealand Ministry of Health (2008)

Conclusions •  This is not rocket science! •  But, health equity practice is something we must commit

to wholeheartedly §  Employ equity experts and/or build capacity in team

§  Must be ongoing and integrated into evaluation and implementation

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The Wellesley Institute

http://www.wellesleyinstitute.com/resource/health-equity-into-actionplanning-and-other-resources-for-lhins/

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Questions/Comments?

Please feel free to email us for more info!"

•  Janine: jfarrell@sfu.ca"•  Travis: travissalway.hottes@bccdc.ca"•  Mark Gilbert: mark.gilbert@bccdc.ca"

"•  Online Services Blog: http://bclovebytes.wordpress.com/"

!