We ran a discovery on chlamydia, to learn more about the condition, the services on offer to test for and treat it, and the needs of patients as well as the long term strategic objectives of NHS.

Connecting people to services

We’ve written before about how we’re trying to help connect people to the specific NHS services that they need.

We’re looking at how we can design a digital service to guide people so they can access NHS services appropriate to their needs and context. Research showed that people are not always aware of the services available, and often default to their GP when they could access alternative services.

Focusing, in order to learn

When we began this work, we identified good examples of symptoms and conditions for which patients can access a range of different healthcare services, such as walk-in centres, minor injury units, and sexual health clinics.

From this list, we picked chlamydia as a first example to explore in-depth as:

  • it’s common
  • it can lead to serious health complications, so it’s important
  • it’s a condition that people may not be aware they’re at risk of
  • there are often no symptoms – so people who have it may not be aware that they do
  • young people, who are at risk, are likely to be digitally active
  • there is a broad range of different services on offer
  • there are localised digital services that we can signpost to

What have we done?

We’ve been exploring the topic of chlamydia in a number of ways:

  • During our desk research stage, we first listed all of our assumptions and biases. In this early stage of research we aimed to validate or invalidate as many assumptions as we could through desk research; utilising resources such as policy documents, national statistics, peer-reviewed academic journals and web analytics.
  • Engaging with stakeholders was important for us in order to gain an in-depth understanding of this subject matter. We spoke to experts at the Department of Health, and the National Chlamydia Screening Programme, which is part of Public Health England. From this we got a better understanding of existing services, policy around chlamydia screening, awareness levels of the STI on a national level, and how we could scale up what we are working on for chlamydia for other STIs. We also spoke to various subject matter specialists who are focused within the sector of STIs, including academic researchers, sexual health service managers, and healthcare professionals like nurses, clinicians and doctors.
  • Telephone interviews with 43 patients who had or have chlamydia. Speaking with people of varying ages, genders and locations who have had chlamydia gave us a rigorous understanding of the pain points, information-seeking behaviours, attitudes and constraints people have. Getting these insights were the foundation of journey mapping the user experience and giving us an evidence-based direction.
  • Our team visited various physical sexual health services, including Dean Street Express and local pharmacies to gain insights and build empathy by experiencing part of the user journey ourselves.
  • A number of our team took chlamydia tests using postal kits. Self-testing kits are a service offered to people who want to be tested for chlamydia. We analysed the service design of self-testing kits, to understand who can get a kit for free, how users get their results and treatment, and how the service differs for each provider.

We created a dashboard to keep track of how many people we’ve spoken with, hours of interviews, and things we still need to do.

dashboard for chlamydia discovery

What have we learned?

We learnt a lot from this research, for example:

  • Embarrassment and social stigma is a barrier for people getting help. People are often too embarrassed to talk to people about chlamydia openly, particularly their family GP.
  • For most people who suspect they have chlamydia, finding a test close to where they live or work is the predominant method for choosing where to go. Although some prefer to find treatment farther away out of embarrassment of seeing someone they might know.
  • People want to understand when they’re at risk – because chlamydia often has no symptoms, and the symptoms could be perceived as ‘normal’ for example discharge or vaginal bleeding.
  • We need to make sure we don’t mislead people. People under 25 are eligible for free self-testing kits. If we tell someone they can get a test for free then direct them to a third-party website that asks them to pay, we might lose their trust.
  • Some people proactively monitor their sexual health by being screened regularly – and these people already know where to go.

Our problem statements have evolved

Before embarking on this research we drafted 3 problem statements that we thought summarised the problem that we were aiming to solve. Having learnt a lot more, we re-drafted 5 slightly different problem statements that better reflect the real problems that we think we can help with.

Measuring impact

We have the capabilities in our team to deliver a national digital service, but we also want to make sure the work we do has some genuine impact. To that end we’re finding out about how we could run a local experiment, to see if we can observe any shift in behaviour after promoting a new digital service.

Prototyping, and scaling up

We’ve learnt a lot, and still think this is a good example of a problem that we can help with, related to people accessing different NHS services.

We’re about to run a design sprint to kick-start our process of prototyping solutions. As we design and iterate our prototypes we’ll also have half an eye on ways in which our solutions can be scaled to many other symptoms, conditions and NHS services.

As we continue working on this service we are always looking to speak with interested stakeholders regarding chlamydia, so if you are interested please let us know.

We have temporarily disabled the comment functionality whilst we make some technical updates. In the meantime, we’d love to hear what you think about our work so tweet us @NHSDigital using the hashtag #NHSTransformationBlog or get in touch at england.digitalhealth@nhs.net.