Opening the digital doorway to sexual healthcare: Recommendations from a behaviour change wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations.
Using a Behaviour Change Wheel analysis of barriers and facilitators among underserved UK populations, this study generated theory-informed recommendations to improve access to online sexual health information and support, including education, training, and environmental restructuring interventions.
Key Findings
Results
Low awareness and familiarity with online sexual health information and support was identified as a key barrier among underserved populations.
Study recruited 35 UK participants from diverse backgrounds using the PROGRESSPlus framework for purposive recruitment
Recruitment took place between 15.10.21 and 18.03.22
51% of participants were from the most deprived areas and 26% were from minoritised ethnic groups
Semi-structured interviews and thematic analysis were used to identify this barrier
Results
Perceptions that online information and support were unlikely to meet the needs of underserved populations constituted a significant barrier to access.
This barrier was identified through thematic analysis of semi-structured interviews
The finding reflects a mismatch between available online content and the specific needs of diverse, underserved groups
This was identified alongside barriers such as lack of personal relevancy and overwhelming volume of information sources
Results
Several structural and design features of online sexual health platforms served as barriers, including chatbots/automated responses, response wait times, and overwhelming volume of information sources.
These barriers were identified through qualitative thematic analysis of 35 participant interviews
Chatbots and automated responses were specifically named as deterrents to seeking online support
The overwhelming volume of information sources was identified as a barrier distinct from issues of content quality or relevancy
Results
Facilitators to seeking online sexual health information and support included clarity about credibility and quality, inclusive content, and in-person assistance.
These facilitators were identified using semi-structured interviews and thematic analysis
In-person assistance was identified as a facilitator, suggesting hybrid digital-physical support models may be beneficial
Inclusive content was highlighted as particularly important for underserved populations including those from minoritised ethnic groups and deprived areas
Results
The Behaviour Change Wheel analysis generated three categories of recommendations: Education and Persuasion, Training and Modelling, and Environmental Restructuring and Enablement.
Education and Persuasion recommendations included online and offline promotion and endorsement by healthcare professionals and peers
Training and Modelling recommendations included accessible training to enhance searching skills and credibility appraisal
Environmental Restructuring and Enablement recommendations included modifications to make online information and support simpler and easier to use, including video/audio options for content
The Behaviour Change Wheel (BCW) framework was applied to map identified barriers and facilitators to intervention functions
Discussion
The study identified that access to many sexual health services is now digital, making the 'digital doorway' a critical point of inequality for underserved populations.
The authors frame online information and support as a prerequisite 'digital doorway' that must be navigated to engage with wider sexual healthcare
Participants included individuals from the most deprived areas (51%) and minoritised ethnic groups (26%), groups identified as underserved
The authors argue that implementing the recommendations 'could reduce inequalities associated with accessing and using online sexual health services'
What This Means
This research suggests that people from disadvantaged backgrounds in the UK face a range of practical and psychological barriers when trying to find sexual health information or support online. The study recruited 35 people from diverse backgrounds — including many from the most deprived areas and from ethnic minority communities — and conducted in-depth interviews to understand what makes it harder or easier for them to use online sexual health resources. Barriers included not knowing where to look, feeling that online content wasn't relevant to people like them, being put off by chatbots and long wait times for responses, and feeling overwhelmed by the sheer number of sources available. On the other hand, things that helped included clear signals of trustworthiness, content that felt inclusive and representative, and having someone available in person to help them navigate.
Using a structured behavioural science tool called the Behaviour Change Wheel, the researchers then translated these findings into concrete recommendations for improving access. These fell into three broad areas: promoting awareness through healthcare workers and peers, providing accessible training to help people search effectively and judge whether sources are reliable, and redesigning online platforms to be simpler and more user-friendly — including offering video and audio formats as alternatives to text.
This research matters because digital tools are increasingly the front door to sexual health services — if someone cannot navigate online information or support, they may never reach the care they need. The findings suggest that without deliberate efforts to make online sexual health resources more accessible, current digital-first approaches to healthcare delivery risk deepening existing health inequalities for people who are already underserved.
McLeod J, Estcourt C, MacDonald J, Gibbs J, Woode Owusu M, Mapp F, et al.. (2025). Opening the digital doorway to sexual healthcare: Recommendations from a behaviour change wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations.. PloS one. https://doi.org/10.1371/journal.pone.0315049