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Article ; Online: Defining the role of digital public health in the evolving digital health landscape: policy and practice implications in Canada.

Iyamu, Ihoghosa / McKee, Geoffrey / Haag, Devon / Gilbert, Mark

Health promotion and chronic disease prevention in Canada : research, policy and practice

2024 Volume 44, Issue 2, Page(s) 66–69

Title translation	Définition du rôle de la santé publique numérique dans le paysage changeant de la santé numérique : répercussions sur les politiques et les pratiques au Canada.
MeSH term(s)	Humans ; Digital Health ; Public Health ; Canada ; Policy
Language	French
Publishing date	2024-02-14
Publishing country	Canada
Document type	Journal Article
ISSN	2368-738X
ISSN (online)	2368-738X
DOI	10.24095/hpcdp.44.2.04
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Article ; Online: Cost-effectiveness of internet-based HIV screening among gay, bisexual and other men who have sex with men (GBMSM) in Metro Vancouver, Canada.

De Anda, Jose A / Irvine, Michael A / Zhang, Wei / Salway, Travis / Haag, Devon / Gilbert, Mark

PloS one

2023 Volume 18, Issue 11, Page(s) e0294628

Abstract: Background: GetCheckedOnline is an internet-based screening service aiming to increase HIV testing among gay, bisexual and other men who have sex with men (GBMSM). We assessed the cost-effectiveness of GetCheckedOnline in its first implementation phase ... ...

Abstract	Background: GetCheckedOnline is an internet-based screening service aiming to increase HIV testing among gay, bisexual and other men who have sex with men (GBMSM). We assessed the cost-effectiveness of GetCheckedOnline in its first implementation phase at different uptake scenarios compared to clinic-based screening services alone in Metro Vancouver, Canada. Methods: From a healthcare payer's perspective, our cost-utility analysis used an established dynamic GBMSM HIV compartmental model estimating the probability of acquiring HIV, progressing through diagnosis, disease stages and treatment over a 30-year time horizon. The base case scenario assumed 4.7% uptake of GetCheckedOnline in 2016 (remainder using clinic-based services), with 74% of high-risk and 44% of low-risk infrequent testers becoming regular testers in five years. Scenario analyses tested increased GetCheckedOnline uptake to 10% and 15%. Results: The cost per test for GetCheckedOnline was $29.40 compared to clinic-based services $56.92. Compared with clinic-based screening services, the projected increase in testing frequency with 4.7% uptake of GetCheckedOnline increased the costs by $329,600 (95% Credible Interval: -$498,200, $571,000) and gained 4.53 (95%CrI: 0, 9.20) quality-adjusted life years (QALYs) in a 30-year time horizon. The probability of GetCheckedOnline being cost-effective was 34% at the threshold of $50,000 per QALY, and increased to 73% at the threshold of $100,000 per QALY. The results were consistent in the other uptake scenarios. The probability of GetCheckedOnline being cost-effective became 80% at the threshold of $50,000 per QALY if assuming 5-year time horizon. Conclusions: GetCheckedOnline is almost half the cost of clinic-based services on a per-test basis. However, increased access to testing should be balanced with risk profiles of patients to ensure the implementation can be a cost-effective strategy for increasing HIV screening among GBMSM in Metro Vancouver. Additional analyses are needed to understand the impact of internet-based screening including screening for other STIs and in other populations.
MeSH term(s)	Male ; Humans ; Sexual and Gender Minorities ; Homosexuality, Male ; Cost-Benefit Analysis ; Canada ; Ambulatory Care Facilities ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Infections/prevention & control
Language	English
Publishing date	2023-11-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0294628
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Article: Defining the Scope of Digital Public Health and Its Implications for Policy, Practice, and Research: Protocol for a Scoping Review.

Iyamu, Ihoghosa / Gómez-Ramírez, Oralia / Xu, Alice X T / Chang, Hsiu-Ju / Haag, Devon / Watt, Sarah / Gilbert, Mark

JMIR research protocols

2021 Volume 10, Issue 6, Page(s) e27686

Abstract: Background: There has been rapid development and application of digital technologies in public health domains, which are considered to have the potential to transform public health. However, this growing interest in digital technologies in public health ...

Abstract	Background: There has been rapid development and application of digital technologies in public health domains, which are considered to have the potential to transform public health. However, this growing interest in digital technologies in public health has not been accompanied by a clarity of scope to guide policy, practice, and research in this rapidly emergent field. Objective: This scoping review seeks to determine the scope of digital health as described by public health researchers and practitioners and to consolidate a conceptual framework of digital public health. Methods: The review follows Arksey and O'Malley's framework for conducting scoping reviews with improvements as suggested by Levac et al. The search strategy will be applied to Embase, Medline, and Google Scholar. A grey literature search will be conducted on intergovernmental agency websites and country-specific websites. Titles and abstracts will be reviewed by independent reviewers, while full-text reviews will be conducted by 2 reviewers to determine eligibility based on prespecified inclusion and exclusion criteria. The data will be coded in an iterative approach using the best-fit framework analysis methodology. Results: This research project received funding from the British Columbia Centre for Disease Control Foundation for Population and Public Health on January 1, 2020. The initial search was conducted on June 1, 2020 and returned 6953 articles in total. After deduplication, 4523 abstracts were reviewed, and 227 articles have been included in the review. Ethical approval is not required for this review as it uses publicly available data. Conclusions: We anticipate that the findings of the scoping review will contribute relevant evidence to health policy makers and public health practitioners involved in planning, funding, and delivering health services that leverage digital technologies. Results of the review will be strategically disseminated through publications in scientific journals, conferences, and engagement with relevant stakeholders. International registered report identifier (irrid): DERR1-10.2196/27686.
Language	English
Publishing date	2021-06-30
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/27686
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Article ; Online: "Mini Dial-A-Nurses" and "Good Brands": What Are the Desirable Features of Online HIV/STI Risk Calculators?

Gómez-Ramírez, Oralia / Thomson, Kim / Salway, Travis / Haag, Devon / Falasinnu, Titilola / Grennan, Troy / Grace, Daniel / Gilbert, Mark

AIDS education and prevention : official publication of the International Society for AIDS Education

2021 Volume 32, Issue 6, Page(s) 528–542

Abstract: A wide variety of risk calculators estimate individuals' risk for HIV/sexually transmitted infections (STI) online. These tools can help target HIV/STI screening and optimize clinical decision-making. Yet, little evidence exists on suitable features for ... ...

Abstract	A wide variety of risk calculators estimate individuals' risk for HIV/sexually transmitted infections (STI) online. These tools can help target HIV/STI screening and optimize clinical decision-making. Yet, little evidence exists on suitable features for these tools to be acceptable to end-users. We investigated the desirable characteristics of risk calculators among STI clinic clients and testing service providers. Participants interacted with online HIV/STI risk calculators featuring varied target audiences, completion lengths, and message outputs. Thematic analysis of focus groups identified six qualities that would make risk calculators more appealing for online client use: providing personalized risk assessments based on users' specific sexual behaviors and HIV/STI-related concerns; incorporating nuanced risk assessment and tailored educational information; supplying quantifiable risk estimates; using non-stigmatizing and inclusive framing; including explanations and next steps; and developing effective and appropriate branding. Incorporating these features in the design of online HIV/STI risk calculators may improve their acceptability among end-users.
MeSH term(s)	Adult ; Female ; Focus Groups ; HIV Infections/prevention & control ; Humans ; Internet ; Male ; Risk Assessment/methods ; Sexual Behavior ; Sexual Health ; Sexually Transmitted Diseases/prevention & control
Language	English
Publishing date	2021-03-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1075448-9
ISSN	1943-2755 ; 0899-9546
ISSN (online)	1943-2755
ISSN	0899-9546
DOI	10.1521/aeap.2020.32.6.528
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Article ; Online: Caught between HIV exceptionalism and health service integration: Making visible the role of public health policy in the scale-up of novel sexual health services.

Gómez-Ramírez, Oralia / MacKinnon, Kinnon R / Bannar-Martin, Sophie / Karlsson, Maja / Haag, Devon / Worthington, Catherine / Gilbert, Mark / Grace, Daniel

Health & place

2021 Volume 72, Page(s) 102696

Abstract: The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for ... ...

Abstract	The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.
MeSH term(s)	Canada ; HIV Infections/prevention & control ; Health Policy ; Health Services ; Humans ; Public Policy
Language	English
Publishing date	2021-11-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1262540-1
ISSN	1873-2054 ; 1353-8292
ISSN (online)	1873-2054
ISSN	1353-8292
DOI	10.1016/j.healthplace.2021.102696
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Article ; Online: Rumination, risk, and response: a qualitative analysis of sexual health anxiety among online sexual health chat service users.

Watt, Sarah / Salway, Travis / Gómez-Ramírez, Oralia / Ablona, Aidan / Barton, Lindsay / Chang, Hsiu-Ju / Pedersen, Heather / Haag, Devon / LeMoult, Joelle / Gilbert, Mark

Sexual health

2022 Volume 19, Issue 3, Page(s) 182–191

Abstract: Background: Anxiety is common among sexual health service users. Accessible, anonymous online sexual health services may offer opportunities to connect users with mental health services, but little is known about anxiety in these settings. We sought to ... ...

Abstract	Background: Anxiety is common among sexual health service users. Accessible, anonymous online sexual health services may offer opportunities to connect users with mental health services, but little is known about anxiety in these settings. We sought to characterise expressions of anxiety among chat users and nurse responses to anxiety. Methods: We conducted inductive thematic analysis of transcripts from an anonymous online sexual health chat service moderated by sexual health nurses. Results: Among chat users, we identified: worry, anxiety, and emotional distress, particularly regarding HIV transmission risk, testing, and symptoms; exaggerated appraisal of HIV-transmission risk associated with sex-related shame and stigma; and patterns of anxiety that were unresolved by HIV education or testing interventions. Although nurses recognised and acknowledged anxiety, their responses to this anxiety varied; some provided anxiety management information, while others offered sexual health education and risk assessment. Conclusions: Targeted interventions addressing HIV-related stigma and anxiety among online sexual health service users are needed to facilitate connections to appropriate mental health supports.
MeSH term(s)	Anxiety/psychology ; HIV Infections/diagnosis ; Humans ; Mental Health ; Sexual Health ; Social Stigma
Language	English
Publishing date	2022-05-22
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2256731-8
ISSN	1449-8987 ; 1448-5028
ISSN (online)	1449-8987
ISSN	1448-5028
DOI	10.1071/SH21198
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Article ; Online: Awareness of and intention to use an online sexually transmitted and blood-borne infection testing service among gay and bisexual men in British Columbia, two years after implementation.

Dulai, Joshun / Salway, Travis / Thomson, Kimberly / Haag, Devon / Lachowsky, Nathan / Grace, Daniel / Edward, Joshua / Grennan, Troy / Trussler, Terry / Gilbert, Mark

Canadian journal of public health = Revue canadienne de sante publique

2020 Volume 112, Issue 1, Page(s) 78–88

Abstract: Objectives: This study assessed gay, bisexual, and other men who have sex with men's (GBMSM) awareness of and intention to use GetCheckedOnline, an online sexually transmitted and blood-borne infection (STBBI) testing service.: Methods: A cross- ... ...

Abstract	Objectives: This study assessed gay, bisexual, and other men who have sex with men's (GBMSM) awareness of and intention to use GetCheckedOnline, an online sexually transmitted and blood-borne infection (STBBI) testing service. Methods: A cross-sectional study was conducted two years after launch among GBMSM > 18 years of age in British Columbia, Canada. Participants were recruited through community venues, clinics, websites, and apps. Results: Of 1272 participants, 32% were aware of GetCheckedOnline. Gay identity, regularly testing at an STBBI clinic, being out to one's healthcare provider, attending GBMSM community venues, and frequent social media use were associated with awareness. Among participants who were aware but had not used GetCheckedOnline, knowing GetCheckedOnline users, using social media, not knowing where else to test, and not wanting to see a doctor were associated with intention to use GetCheckedOnline. Conclusion: Early promotion of GetCheckedOnline resulted in greater awareness among those connected to GBMSM.
MeSH term(s)	Adult ; Blood-Borne Infections/diagnosis ; British Columbia ; Cross-Sectional Studies ; Health Knowledge, Attitudes, Practice ; Homosexuality, Male/psychology ; Homosexuality, Male/statistics & numerical data ; Humans ; Intention ; Internet-Based Intervention ; Male ; Mass Screening/methods ; Middle Aged ; Sexual and Gender Minorities/psychology ; Sexual and Gender Minorities/statistics & numerical data ; Sexually Transmitted Diseases/diagnosis ; Young Adult
Language	English
Publishing date	2020-06-16
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	417262-0
ISSN	1920-7476 ; 0008-4263
ISSN (online)	1920-7476
ISSN	0008-4263
DOI	10.17269/s41997-020-00323-4
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Article ; Online: Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada.

Sang, Jordan M / Wong, Jason / Ryan, Venessa / Cumming, Emma / Wang, Lu / Cui, Zishan / Bacani, Nicanor / Haag, Devon / Lachowsky, Nathan J / Cox, Joseph / Grace, Daniel / Otterstatter, Michael / Morshed, Muhammad / Edward, Joshua / Grennan, Troy / Arkles, Jillian / Brownrigg, Bobbi / Hogg, Robert S / Moore, David M

Canadian journal of public health = Revue canadienne de sante publique

2022 Volume 114, Issue 2, Page(s) 295–307

Abstract: Objectives: Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing ... ...

Abstract	Objectives: Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC. Methods: We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing. Results: Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p < 0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p = 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93). Conclusion: gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.
MeSH term(s)	Male ; Humans ; Syphilis/diagnosis ; Syphilis/epidemiology ; Syphilis/prevention & control ; Sexual and Gender Minorities ; Homosexuality, Male ; British Columbia/epidemiology ; Sexual Behavior ; HIV Infections/prevention & control
Language	English
Publishing date	2022-09-26
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	417262-0
ISSN	1920-7476 ; 0008-4263
ISSN (online)	1920-7476
ISSN	0008-4263
DOI	10.17269/s41997-022-00690-0
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Article ; Online: Click yes to consent: Acceptability of incorporating informed consent into an internet-based testing program for sexually transmitted and blood-borne infections.

Gilbert, Mark / Bonnell, Amanda / Farrell, Janine / Haag, Devon / Bondyra, Mark / Unger, David / Elliot, Elizabeth

International journal of medical informatics

2017 Volume 105, Page(s) 38–48

Abstract: Background: Autonomous use of online health care services without interaction with a health care provider challenges existing models for achieving informed consent (IC); current examinations of this issue have focused on commercial direct-to-consumer ... ...

Abstract	Background: Autonomous use of online health care services without interaction with a health care provider challenges existing models for achieving informed consent (IC); current examinations of this issue have focused on commercial direct-to-consumer genetic testing. As IC is integral to publicly funded clinical testing services, we incorporated pre-test concepts necessary for IC in GetCheckedOnline (GCO), British Columbia's online sexually transmitted and blood-borne infection (STBBI) testing service. Objective: We assessed the acceptability of this IC step and its design options among potential users during usability testing of GCO. Methods: English-speaking participants≥19years were recruited from Craigslist and among provincial STI clinic clients for usability testing of an early version of GCO, which included a consent webpage presenting 8 pre-test statements for review prior to completing testing. Participants were interviewed regarding their acceptability, perceptions, and understanding of the consent page; transcripts were analyzed thematically. Results: We conducted 13 interviews (9 males, 4 females; 9 self-identified as heterosexual; all had previously tested for STBBI). We identified three main themes: i) the meaning of IC (consent page viewed as important and for protection of individual and organization; participants demonstrated varying understandings of specific components); ii) the impact of previous experience on understanding IC (participants understood difference between online and in-person testing; IC concepts were better understood by participants with more testing experience); iii) the role of website design on achieving IC (design of page to disrupt speedy click-throughs was valued and demonstrated seriousness of the consent page). Conclusions: Our careful attention to both content and design of the consent page of GCO was highly valued by potential users of the service, and effective in disrupting routinization of consent on websites. We argue that principles of IC apply equally in online self-testing programs as in clinical practice, and can be effectively achieved without detracting from the user experience.
Language	English
Publishing date	2017-09
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	1466296-6
ISSN	1872-8243 ; 1386-5056
ISSN (online)	1872-8243
ISSN	1386-5056
DOI	10.1016/j.ijmedinf.2017.05.020
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Article ; Online: Qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who use

Knight, Rod Eric / Chabot, Cathy / Carson, Anna / Thomson, Kimberly / Haag, Devon / Gilbert, Mark / Shoveller, Jean

Sexually transmitted infections

2019 Volume 95, Issue 2, Page(s) 145–150

Abstract: Objectives: To describe the factors that influence gay, bisexual and other men who have sex with men's (gbMSM) experiences with : Methods: Drawing on a purposive stratified sampling framework, we conducted 37 in-depth semistructured interviews with ... ...

Abstract	Objectives: To describe the factors that influence gay, bisexual and other men who have sex with men's (gbMSM) experiences with Methods: Drawing on a purposive stratified sampling framework, we conducted 37 in-depth semistructured interviews with gbMSM who had used GCO at least once between 2015 and 2017. Results: Participants expressed a preference for GCO (instead of clinic-based testing) because of convenience, privacy and control over specimen collection (specifically with doing one's own throat or anal swab). Participants preferred receiving their results online via GCO compared with phone or email follow-up by clinic staff. GCO was viewed positively because it offers gbMSM living outside of urban city centres easy access to diagnostic services, including access to pooled nucleic acid amplification testing. Many participants also continued to positively view the clinic-based services available for gbMSM in their community. These services were frequently described as highly competent, tailored and comprehensive in responding to more complex needs. For example, attending a clinic was viewed as preferential to GCO in instances where there was a desire to access services addressing co-occurring health issues (eg, mental health; substance use disorders). Almost all of the participants anticipated using both GCO and clinic-based services in the future. Conclusions: gbMSM report positive experiences and perceptions of GCO; however, they do not view GCO as a panacea. The results of this study point to the need to ensure that a wide range of integrated service options (eg, online; clinic-based) are available to address the range of sexual health needs of gbMSM living in BC's diverse settings.
MeSH term(s)	Adult ; Aged ; British Columbia ; Delivery of Health Care ; Diagnostic Services/statistics & numerical data ; Diagnostic Tests, Routine/statistics & numerical data ; HIV/genetics ; HIV Infections/diagnosis ; Homosexuality, Male/psychology ; Humans ; Internet ; Male ; Middle Aged ; Patient Preference ; Qualitative Research ; Risk Assessment ; Sexual Behavior ; Sexual Partners ; Sexual and Gender Minorities/psychology ; Sexually Transmitted Diseases/diagnosis ; Young Adult
Language	English
Publishing date	2019-01-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1420303-0
ISSN	1472-3263 ; 1368-4973
ISSN (online)	1472-3263
ISSN	1368-4973
DOI	10.1136/sextrans-2018-053645
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