Evaluating completion rates between kiosk and smartphone computer-assisted self-interviewing at a sexual health clinic in Melbourne: a before-and-after implementation study.
The transition from kiosks to smartphones for administering CASI was associated with a modest, but consistent, decline in data completeness, with smartphone use associated with a 15.31 percentage point reduction in completeness after adjusting for confounding factors.
Key Findings
Results
Mean questionnaire completeness was significantly lower in the smartphone group compared with the kiosk group.
Mean completeness was 36.2% in the smartphone period versus 54.0% in the kiosk period (P < 0.0001).
The study included 56,095 eligible consultations: 28,093 in the kiosk period and 28,002 in the smartphone period.
Data were drawn from January to June 2023 (kiosk period) and January to June 2024 (smartphone period) at Melbourne Sexual Health Centre.
The Digital Front Door smartphone platform replaced touchscreen kiosks in December 2023.
Results
The proportion of clients who did not respond to any single question (0% completeness) increased from the kiosk period to the smartphone period.
During the kiosk period, 45.1% (12,676/28,093) of clients had 0% completeness.
During the smartphone period, 57.4% (16,065/28,002) of clients had 0% completeness.
This represents an increase of approximately 12.3 percentage points in non-response between the two periods.
Results
Smartphone use was independently associated with a reduction in CASI completeness after adjusting for confounding factors.
Smartphone use was associated with a 15.31 percentage point reduction in completeness (β = -15.31, 95% CI: -16.12 to -14.49).
Analysis used linear regression with generalised estimating equations to examine associations between completeness and individuals' characteristics.
The model adjusted for multiple confounding factors including age, birth region, Indigenous identity, HIV status, and attendance history.
Results
Older age was independently associated with reduced CASI completeness.
Older age was identified as an independent predictor of reduced completeness in multivariate analysis.
This association persisted after adjustment for other confounding factors including platform type.
The finding suggests age-related differences in digital tool engagement within a sexual health clinic population.
Results
Birth outside Oceania was independently associated with reduced CASI completeness.
Being born outside Oceania was independently associated with lower questionnaire completeness.
This association was identified after adjusting for other confounding factors including platform type and age.
The finding highlights potential language or cultural barriers to digital self-reporting tool engagement.
Results
Indigenous identity and living with HIV were independently associated with reduced CASI completeness.
Indigenous identity was identified as an independent predictor of reduced completeness in adjusted analyses.
People living with HIV also demonstrated independently reduced completeness.
Both associations persisted after adjustment for platform type and other confounding factors.
Results
First-time attendees demonstrated substantially higher completeness compared to returning clients.
First-time attendees showed substantially higher CASI completeness in both periods.
This finding was noted as an independent association in adjusted analyses.
The authors suggest familiarity with the clinic setting or system may influence response behavior over time.
Discussion
Incomplete CASI data may reduce clinic efficiency by requiring clinicians to collect missing information during consultations.
The authors note that incomplete CASI data poses challenges in high-demand settings.
Clinicians may need to collect missing sexual history information verbally during consultations when CASI data are incomplete.
The authors call for further research to assess whether response completeness improves as users become more familiar with the new digital system.
What This Means
This research suggests that switching from touchscreen kiosks to a smartphone-based system for collecting patients' sexual health information before clinic appointments led to a meaningful drop in how completely patients filled out the questionnaires. At Melbourne Sexual Health Centre, when the clinic moved from kiosk-based to smartphone-based self-reporting in late 2023, the average proportion of questions answered fell from about 54% to 36%. More than half of patients in the smartphone period didn't answer a single question, compared to about 45% in the kiosk period.
The study also found that certain groups of patients were less likely to complete the questionnaires regardless of which system was used, including older patients, those born outside Oceania, Indigenous patients, and people living with HIV. Interestingly, patients visiting the clinic for the first time were more likely to complete the questionnaire fully than returning patients.
This research suggests that the choice of digital platform matters for collecting sensitive health information in clinical settings. When patients don't complete pre-consultation questionnaires, clinic staff have to spend additional time gathering that information during appointments, which can slow down busy clinics. The authors note that familiarity with the new smartphone system may improve over time, and they call for further research to track whether completion rates recover as patients become more accustomed to the new format.
Wijekoon D, Latt P, Fairley C, Ong J, Chen M, Rahman R, et al.. (2026). Evaluating completion rates between kiosk and smartphone computer-assisted self-interviewing at a sexual health clinic in Melbourne: a before-and-after implementation study.. Sexual health. https://doi.org/10.1071/SH25119