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44 Understanding disruption in sexual health through the implementation of online postal self-sampling
  1. Tommer Spence,
  2. Jessica Sheringham,
  3. Alison Howarth,
  4. Jo Gibbs,
  5. Fiona Burns
  1. University College London, UK


Background Online postal self-sampling (OPSS) allows people to test for sexually transmitted infections by ordering a kit online, taking samples at home and posting them to a lab for analysis. Its use in England has increased rapidly over the past decade, however there is limited research on the implementation and impact of OPSS. The ASSIST study sought to understand this in three case study cities, with disruption coming through as a dominant theme.

Methods We interviewed 60 sexual health staff and stakeholders, conducted an analysis of 57 implementation documents and undertook contextual observation at three clinics. Data collection and analysis were informed by Normalisation Process Theory.

Results We identified three disruptive events which shaped OPSS implementation:

  1. Austerity: Sexual health became a local government responsibility in 2013, exposing it to significant funding cuts. Spending reduced by 18% between 2013-14 and 2021-22, while incidence of chlamydia, gonorrhoea and syphilis grew over the same period. This contributed to the decision to adopt OPSS in some cities, as it was seen as a cost-saving initiative.

  2. COVID-19: Lockdowns accelerated the implementation of OPSS in some cities, with access to clinics restricted. In other cities, it caused implementation to reverse, due to resources being redirected towards pandemic response or delivery models becoming unaffordable because of rapid, unexpected increases in OPSS use.

  3. Mpox: The epidemic in 2022 required at-risk individuals to be examined and/or vaccinated in sexual health clinics. Occurring immediately after COVID-19, it exacerbated many of the challenges services were facing but also enabled OPSS and clinic access to be rebalanced in some areas.

Discussion Sexual health services have been particularly vulnerable to disruption over the past decade, although the impact of this has varied depending on context. Although it can be damaging, it has enabled innovation and service improvement in some circumstances.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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