How online sexual health services could work; generating theory to support development.
How online sexual health services could work; generating theory to support development.
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DOI：
10.1186/s12913-015-1200-x
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发表时间：
2015-12-05
影响因子：
2.8
通讯作者：
Holdsworth G
中科院分区：
文献类型：
--
作者：
Baraitser P;Syred J;Spencer-Hughes V;Howroyd C;Free C;Holdsworth G
在线性健康服务是一个新兴的服务提供领域。变革理论通过指定计划的投入和阐明将这些投入与预期结果联系起来的因果途径来批判性地分析项目。它承认这些关系的变化和有争议的性质。我们为在线性健康服务开发了两个版本的变化理论。第一份报告阐述了原方案提案中提出的理论，第二份报告通过与主要方案利益攸关方的访谈记录了其在执行早期阶段的发展情况。方案提案描述了一个自主和授权的用户使用更方便、更容易获得和更谨慎的在线服务完成性健康检查，以及从基于诊所到在线护理的转变。利益相关者访谈证实了这一点，并描述了新的、更复杂的服务使用模式，因为在线服务为提供者创造了在传统诊所访问之外联系用户的机会，用户在在线和基于诊所的护理之间移动。他们描述了新型的用户/供应商关系，我们将其归类为：受在线零售文化影响的关系；受健康促进外展和监测影响的人以及承认需要获得支助的人。共同发展诊所和网上服务，以支持复杂的服务使用模式。为那些可以在支持下使用在线服务的人提供使用在线服务的途径。将性健康服务的用户体验理解为在某些情况下增加用户的自主权和选择；在他人身上制造排斥和需要支持，在其他人身上制造干扰和缺乏控制。对利益攸关方对在线性健康服务可能产生的影响的看法的分析提出了三个需要进一步思考和研究的领域。这项工作影响了对该方案的评价，该方案将侧重于；绘制使用模式，以了解用户如何在在线和基于诊所的服务之间移动；在某些人群中使用在线服务的障碍以及如何克服这些障碍；了解用户对在线服务自主性的看法。
Online sexual health services are an emerging area of service delivery. Theory of change critically analyses programmes by specifying planned inputs and articulating the causal pathways that link these to anticipated outcomes. It acknowledges the changing and contested nature of these relationships. We developed two versions of a theory of change for an online sexual health service. The first articulated the theory presented in the original programme proposal and the second documented its development in the early stages of implementation through interviews with key programme stakeholders. The programme proposal described an autonomous and empowered user completing a sexual health check using a more convenient, accessible and discreet online service and a shift from clinic based to online care. The stakeholder interviews confirmed this and described new and more complex patterns of service use as the online service creates opportunities for providers to contact users outside of the traditional clinic visit and users move between online and clinic based care. They described new types of user/provider relationships which we categorised as: those influenced by an online retail culture; those influenced by health promotion outreach and surveillance and those acknowledging the need for supported access. Co-development of clinic and online services to support complex patterns of service use. Developing access to online services for those who could use them with support. Understanding user experience of sexual health services as increasing user autonomy and choice in some situations; creating exclusion and a need for support in others and intrusiveness and a lack of control in still others. This analysis of stakeholder views on the likely the impacts of online sexual health services suggests three areas for further thinking and research. This work has influenced the evaluation of this programme which will focus on; mapping patterns of use to understand how users move between the online and clinic based services; barriers to use of online services among some populations and how to overcome these; understanding user perceptions of autonomy in relation to online services.