1. Advancing Health Equity in
Online Sexual Health Services
Gay Men s Health Summit 2011
November 3, 2011
SummaryeditProposal
Click to of Master subtitle style
Janine Farrell, Simon Fraser University
Travis Salway Hottes, BC Centre for Disease Control
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2. 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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3. 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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4. 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 Clients
accessing accessing
online clinic
services services
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5. GetCheckedBC
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6. 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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7. 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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8. Timelines and Priority Groups
2009 - 2010
Establish • Public health
Collaborations • Community partner organizations
• End users (focus groups, usability testing of prototype)
2010 - 2011
Planning & • Ongoing consultation
Development • Privacy and technical assessments
• HEIA and other formative evaluation work
2012 - 2013
Phase I: Pilot & • GetCheckedBC piloted at 2 BCCDC Clinics
Evaluation
• Targeted promotion to gay men in Vancouver
Phase II: 2013 - 2014
Broader • Upon successful completion of pilot, expansion to other sites
Implementation throughout province
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9. 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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10. 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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11. 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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12. 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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13. Health Equity Impact Assessment
1. Screening
2. Scoping
3. Impact Assessment
• Literature Review
• Online services immersion
4. Monitoring Must be completed after
5. Evaluation program implementation
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14. Findings
• Potential missed infection (Harm)
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15. Recommendations and Next Steps
• Add pharyngeal/rectal swabs and Hepatitis C testing "
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16. Findings
• High expected uptake in priority populations (benefit)
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17. 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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18. 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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19. 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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20. 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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21. Findings
• Content of site may exclude underserved and
stigmatized populations (reinforce inequity) – e.g. of
stock images , language
≠
• Targeted promotion of service may
reinforce limited ideas about about
who should test (reinforce inequity)
Source: blog.poz.com
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22. Findings
• Youth have unique barriers (reinforce inequity)
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23. 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)
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24. 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
The Health Equity Assessment Tool: A User’s Guide produced by the
New Zealand Ministry of Health (2008)

25. The Wellesley Institute
http://www.wellesleyinstitute.com/resource/health-equity-into-actionplanning-and- 25
other-resources-for-lhins/

26. 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/"
!
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