'I wouldn't trust it …' Digital transformation of young people's sexual health services: a systems-informed...

Digital sexual health technologies for young people, such as websites, texting services and apps, could address some of the sexual health inequalities that many experience, since they have the potential to overcome concerns associated with traditional clinic based services such as embarrassment, privacy and accessibility. However, they are currently under-utilised internationally.

Using complexity theory and systems thinking as a theoretical framework, this qualitative descriptive study sought to explore the acceptability of digital sexual health technologies for 16-18 year olds. Data generation with 10 sexual health nurses with experience of digital service delivery took the form of minimally structured online one-to-one interviews lasting between 20 and 50 min. Focus groups of up to eight young people or individual interviews were used to explore 32 16-18 year olds' perspectives. Interviews lasted between 18 and 48 min. Both datasets were analysed using Braun and Clarke's reflexive thematic analysis.

Three themes emerged from each dataset. Nurses' themes were: (1) digital sexual health services can be more comfortable for young people, (2) digital sexual health services can be complimentary to clinic visits but do not replace them and (3) challenges exist in providing sexual health services to young people through digital technologies. The young people's themes were: (1) sexual health is a 'difficult issue', (2) young people have specific expectations yet a desire for choice and (3) digital health interventions are not a panacea.

While digital sexual health interventions hold great potential, they need to be integral to the wider systems in which both young people and sexual health promotion services operate, otherwise there is a risk that their impact will be compromised. Collaborative approaches that connect causal factors and policy objectives and involve full engagement with all stakeholders are more likely to be efficacious.