'It's less traumatic because you're in your own home': exploring trauma-informed care for digital sexual health services - a secondary qualitative data analysis.
Conway A, Gibbs J, et al. • Sexually transmitted infections • 2026
Online postal self-sampling for sexual health facilitates several trauma-informed care principles by offering privacy, comfort, and control, but gaps remain including limited peer support and concerns about providing sensitive information online.
Key Findings
Results
Online postal self-sampling was perceived by participants as offering more privacy, comfort, and control than in-person testing.
Participants described being in their own home as less traumatic than attending a clinic
The title quote 'It's less traumatic because you're in your own home' reflects a core participant sentiment
Privacy and comfort at home were consistently identified as benefits supporting the TIC principle of Safety
This finding emerged across analysis of 11 transcripts drawn from two mixed methods studies
Results
Participants appreciated the use of gender-inclusive language in online sexual health services and identified online postal self-sampling as a safer option for individuals who fear being misgendered in clinical settings.
Gender-inclusive language on digital platforms was highlighted as a positive feature by participants
Online services were seen as reducing exposure to the risk of misgendering that exists in face-to-face clinical environments
This finding relates to the TIC theme of 'Cultural, Historical and Gender Issues'
The finding emerged from secondary analysis of qualitative interview data
Results
Some participants expressed concern about providing sensitive information online, including information about sexual partners or gender identity.
Despite the overall perception of online services as safer, data privacy was a source of anxiety for some users
Sensitive disclosures such as gender identity and partner information were areas of specific concern
This finding represents a gap in the TIC principle of Trust and Transparency in digital platforms
Concerns about online data security were identified as a barrier to full engagement with digital sexual health services
Results
There was limited evidence of peer support within current digital sexual health services, representing a gap in trauma-informed care delivery.
Peer Support and Self-Help was identified as one of six key TIC themes but showed limited presence in existing digital services
The absence of peer support mechanisms was noted as a shortcoming of current online platforms
This finding aligns with the TIC framework theme of 'Peer Support and Self-Help'
The gap was identified through inductive-deductive thematic analysis of 11 selected interview transcripts
Results
Participants recommended improved signposting to sexual assault reporting and other trauma-related resources within digital sexual health services.
Inadequate signposting to trauma-related support was identified as a specific gap in current digital services
Participants specifically mentioned sexual assault reporting resources as an area needing better integration
This recommendation reflects unmet need within the TIC principles of Collaboration and Choice and Safety
The finding suggests digital platforms are not yet fully connecting users to trauma support pathways
Methods
Six key themes of trauma-informed care were identified as relevant to digital sexual health services: Safety, Trust and Transparency, Peer Support and Self-Help, Collaboration and Choice, and Cultural, Historical and Gender Issues.
An inductive-deductive approach was used to analyse the data against the TIC framework
Data came from secondary analysis of transcripts from two mixed methods studies with n=100 and n=25 sexual health service users respectively
A sample of 11 transcripts was selected using purposive sampling from the combined dataset
This is described as the first known qualitative study exploring the intersection between TIC and digital sexual health interventions
Background
Trauma is associated with adverse sexual and reproductive health outcomes including a higher prevalence of sexually transmitted infections.
The association between trauma and STI prevalence is cited as a rationale for implementing TIC in sexual health services
Trauma is defined as 'an event or circumstance causing an individual physical and/or emotional harm'
TIC is described as 'a systematic framework that recognises and addresses the impact of trauma through an organisation's policies, practices and environment'
Online delivery of sexual health services has rapidly become a standard of care in England, making TIC adaptation to digital platforms a relevant priority
What This Means
This research suggests that online sexual health testing services — where people order test kits by post and self-sample at home — naturally support several principles of trauma-informed care, a framework designed to make healthcare safer and more accessible for people who have experienced trauma. People who used these digital services reported feeling more comfortable, private, and in control compared to visiting a clinic in person, and some described the home environment as less traumatic. For gender-diverse individuals, online services also reduced the fear of being misgendered, which can be a source of distress in face-to-face settings.
However, the study also found important gaps. There was little evidence of peer support being built into digital sexual health platforms, and some users worried about the security of sensitive personal information they were asked to share online, such as details about sexual partners or gender identity. Participants suggested that digital services should do more to direct users toward resources related to sexual assault and trauma support, which are currently not well integrated into online testing pathways.
This matters because a growing number of people access sexual health services entirely online, and people who have experienced trauma may be among those most likely to prefer or rely on these digital options. The research highlights that while digital platforms have some natural advantages for trauma-informed care, deliberate design choices — such as better links to support services, stronger data privacy reassurances, and peer support features — are needed to fully meet the needs of people affected by trauma.
Conway A, Gibbs J, Spence T, Howarth A, Reid D, Estcourt C, et al.. (2026). 'It's less traumatic because you're in your own home': exploring trauma-informed care for digital sexual health services - a secondary qualitative data analysis.. Sexually transmitted infections. https://doi.org/10.1136/sextrans-2024-056442