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BackgroundWeb or Internet-based surveys are increasingly popular in health survey research. However, the strengths and challenges of Web-based surveys with people living with human immunodeficiency virus (HIV) are unclear. ObjectiveThe aim of this article is to describe our experience piloting a cross-sectional, Web-based, self-administered survey with adults living with HIV using a community-based participatory research approach. MethodsWe piloted a Web-based survey that investigated disability and rehabilitation services use with a sample of adults living with HIV in Canada. Community organizations in five provinces emailed invitations to clients, followed by a thank you/reminder one week later. We obtained survey feedback in a structured phone interview with respondents. Participant responses were transcribed verbatim and analyzed using directed content analysis. ResultsOf 30 people living with HIV who accessed the survey link, 24/30 (80%) initiated and 16/30 (53%) completed the survey instrument. A total of 17 respondents participated in post-survey interviews. Participants described the survey instrument as comprehensive, suggesting content validity. The majority (13/17, 76%) felt instruction and item wording were clear and easy to understand, and found the software easy to navigate. Participants felt having a pop-up reminder directing them to missed items would be useful. ConclusionsStrengths of implementing the Web-based survey included: our community-based participatory approach, ease of software use, ability for respondents to complete the questionnaire on one’s own time at one’s own pace, opportunity to obtain geographic variation, and potential for respondent anonymity. Considerations for future survey implementation included: respondent burden and fatigue, the potentially sensitive nature of HIV Web-based research, data management and storage, challenges verifying informed consent, varying computer skills among respondents, and the burden on community organizations. Overall, results provide considerations for researchers conducting community-based participatory Web-based survey research with people living with HIV.

About 50% of people living with HIV will develop HIV-associated neurocognitive disorder (HAND) during their lifetime, and we know that cognitive issues are a concern for people living with HIV. However, limited information exists regarding how HAND is managed and coped with, or how cognitive issues are discussed with others, including health care professionals. Following a community-based research approach, we conducted 25 interviews in 2016 aimed to (1) build the capacity of people living with HIV, (2) facilitate participant recruitment and data collection, (3) increase the validity and reliability of our data analysis results, and (4) facilitate knowledge transfer and exchange regarding HAND. After thorough training, we engaged a number of peer researchers living with HAND in the analysis and knowledge transfer and exchange (KTE) phases of the study. This engagement prompted a number of tensions between the clinicians and the peers that we learned to navigate and make productive. We conclude that it is possible to engage patients and providers only if careful attention, time and human resources are provided to navigating the emerging tensions. The outcomes of our study suggest that engaging an interdisciplinary team across multiple sites with PRAs is a valuable method for comprehensively exploring the lived experience of a complex chronic condition such as HAND.

OBJECTIVE: HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16-64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing. METHODS: A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex. RESULTS: Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age DISCUSSION: Sex differences should be considered when designing interventions to increase testing uptake. Jurisdictional factors, including HIV prevalence and testing modality, should be investigated further. KEY WORDS: HIV; testing; anonymous testing; Canada Can J Public Health 2015;106(2):e4-e9 doi: 10.17269/CJPH.106.4625 OBJECTIF: Le depistage du VIH demeure une strategie centrale en matiere de prevention du virus, car il permet d'aiguiller les personnes seropositives vers les traitements et le soutien disponibles. Au Canada, les lignes directrices nationales ont change recemment dans le cadre des soins primaires normalises, et l'on recommande maintenant le depistage volontaire du VIH pour les 16 a 64 ans. A l'aide des resultats d'une enquete representative nationale, nous avons examine les facteurs individuels et les facteurs lies a la region administrative associes au depistage volontaire. METHODES: En tout, 2 139 participants ont ete echantillonnes selon un processus de recrutement en deux etapes, stratifie selon la region. Des entretiens en anglais ou en franpais (par telephone ou en ligne) ont ete menes en mai 2011. Le depistage volontaire etait defini comme etant un depistage au moins une fois pour une raison autre que pour donner du sang, a des fins d'assurance ou decontrole des immigrants ou pour participer a une etude de recherche. Des analyses de regression logistique ponderees (incluant les facteurs sociodemographiques, d'activite sexuelle, de connaissance du VIH et du sida et les facteurs de prevalence du VIH et de disponibilite du depistage anonyme selon la region administrative) ont ete menees pour l'echantillon global, puis stratifiees selon le sexe. RESULTATS: Vingt-neuf p. cent (29 %) des participants de l'enquete ont declare avoir subi au moins un depistage volontaire du VIH au cours de leur vie. Pour le modele utilisant l'echantillon entier, les facteurs suivants ont ete associes a une probabilite de depistage accrue : l'age DISCUSSION: Il faudrait tenir compte des differences entre les sexes lorsqu'on conpoit des interventions pour accroftre le recours au depistage. Les facteurs comme la prevalence du VIH et les modalites de depistage dans la region administrative devraient faire l'objet d'etudes plus poussees. MOTS CLES: VIH; depistage; depistage anonyme; Canada, Despite a range of educational campaigns and policies designed to increase voluntary human immunodeficiency virus (HIV) testing in Canada, one in four Canadians living with the disease are unaware of [...]

Introduction: We sought to explore the professional, personal and community domains of physician retention in 4 rural communities in Alberta and to develop a preliminary framework for physician retention. Methods: We used a qualitative, collective case study design to study 4 rural communities (cases) in Alberta that retained family physicians for 4 years or longer. Participants included physicians, staff members, spouses and community members. Data collected from interviews, documents and observations were analyzed individually, and similarities and differences across all cases were assessed. Results: A range of factors that could influence physicians' decisions to stay in a particular community were described by participants. Within the professional domain, physician supply, physician dynamics, scope of practice and practice set-up were common across all communities, and innovation, and management and support emerged from some communities. The personal factors, goodness-of-fit, individual choice, and spousal and family support were present in all communities. Four community factors--appreciation, connection, active support, and physical and recreational assets--emerged across all communities, and reciprocity was present in 3 communities. From these data, we developed a preliminary retention framework. Conclusion: Physicians, policy-makers and community members are encouraged to consider the 3 retention domains of professional, personal and community. Introduction : Nous avons voulu explorer les dimensions professionnelle, personnelle et communautaire de la fidelisation des medecins dans quatre communautes rurales de l'Alberta et elaborer un cadre preliminaire de fidelisation des effectifs medicaux. Methodes : Nous avons employe un modele d'etude de cas qualitatif et collectif pour analyser quatre communautes rurales (cas) de l'Alberta qui ont conserve leurs medecins de famille pendant quatre ans ou plus. Les participants incluaient des medecins, des employes, des conjoints et des membres de la communaute. Les donnees recueillies a partir d'entrevues, de documents et d'observations ont fait l'objet d'analyses individuelles et nous avons evalue les similitudes et les differences entre tous les cas. Resultats : Les participants ont decrit un eventail de facteurs susceptibles d'influer sur la decision des medecins de rester dans une communaute en particulier. Pour ce qui est de la dimension professionnelle, l'offre de medecins et la dynamique des medecins, de meme que le champ de pratique et l'organisation de la pratique ont ete des facteurs communs a toutes les communautes, tandis que l'innovation, la gestion et le soutien se sont distingues dans certaines. Parmi les facteurs personnels, mentionnons le degre d'ajustement, les choix personnels et le soutien des conjoints et de la famille, observes dans toutes les communautes. Quatre facteurs communautaires, soit l'appreciation, les liens, le soutien actif et les installations materielles et recreatives, sont ressortis dans toutes les communautes, tandis que la reciprocite a ete notee dans trois communautes. A partir de ces donnees, nous avons elabore un cadre preliminaire pour favoriser la fidelisation. Conclusion : Nous encourageons les medecins, les decideurs et les membres de la communaute a tenir compte de ces trois dimensions de la fidelisation : professionnelle, personnelle et communautaire., INTRODUCTION Primary care physicians provide a variety of health services to rural areas (1,2) and contribute to the health and well-being of rural residents and communities. (3) Yet, health care [...]

Objectives: To examine differences in health risks, health outcomes and health services use of Calgary street-involved youth by level of street involvement to inform services planning. Method: 355 street-involved youth (61% male, 26% Aboriginal) completed surveys at a variety of outdoor and agency locations: 46% currently lived on the street, 33% had lived on the street in the past, and 20% were street-involved but had not lived on the street. Odds Ratios (OR) adjusted for sex, ethnocultural group, and age group were calculated for each health/health risk and health service factor by level of street involvement. Results: With the exception of condom use, significant health and health risk outcome differences were seen by level of street involvement. Use of hospitals and walk-in clinics did not differ significantly by level of street involvement; however, youth living on the street were less likely (OR 0.2) than those who had not lived on the street to use a physician during office hours, and those who had lived on the street were more likely (OR 10.1) to use mobile clinics, services that are targeted to street-involved people. Conclusion: Street-involved youth who had not lived on the street showed better health/health risk outcomes than those who currently or had lived on the street, and health services use showed some differences by level of street involvement. Public health and other service providers need to be cognizant of their role in providing prevention, safety or stabilization services for youth at different stages of street life. Key words: Street youth; health risks; health services utilization; community-based research Objectifs : Examiner les ecarts dans les risques sanitaires, les resultats cliniques et l'utilisation des services de sante par les jeunes de la rue de Calgary selon leur niveau d'itinerance, afin d'etayer la planification des services. Methode: Trois cent cinquante-cinq jeunes de la rue (de sexe masculin a 61 %, autochtones a 26 %) ont repondu a un sondage a divers endroits a l'exterieur et a l'interieur d'organismes: 46 % vivaient actuellement dans la rue, 33 % y avaient deja vecu, et 20 % n'y avaient pas vecu, mais frequentaient le milieu. Nous avons calcule des rapports de cotes (RC) rajustes selon le sexe, le groupe ethnoculturel et le groupe d'age pour chaque facteur de sante/de risque sanitaire et de service de sante selon le niveau d'itinerance des jeunes. Resultats: A l'exception du port du condom, nous avons observe des ecarts significatifs dans les resultats de sante et les risques sanitaires selon le niveau d'itinerance. La frequentation des hopitaux et des cliniques sans rendez-vous ne differait pas significativement selon le niveau d'itinerance, mais les jeunes vivant dans la rue etaient moins susceptibles (RC 0,2) que ceux qui n'avaient pas vecu dans la rue de consulter un medecin pendant les heures de bureau, et ceux qui avaient deja vecu dans la rue etaient plus susceptibles (RC 10,1) de frequenter les unites sanitaires mobiles (un service qui cible les personnes de la rue). Conclusion: Les jeunes qui n'avaient pas vecu dans la rue affichaient de meilleurs resultats sur le plan de la sante et des risques sanitaires que ceux qui vivaient actuellement ou qui avaient deja vecu dans la rue, et l'utilisation des services de sante variait quelque peu selon le niveau d'itinerance. Les intervenants en sante publique et autres fournisseurs de services doivent etre conscients de leur role lorsqu'ils offrent des services de prevention, de securite ou de stabilisation aux jeunes a differents stades d'itinerance. Mots cles: jeunes de la rue; risques sanitaires; utilisation des services de sante; recherche en milieu communautaire, Health issues faced by street youth in Canada are of growing concern for public health, as homelessness and health become critical social issues. (1) The health risks of street-involved youth [...]

Grandparents, and particularly grandmothers, are an important source of family support for parents of young children with developmental disabilities. This study, examines the relationship between parenting stress of mothers and [...]

Introduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada - a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants' service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants' structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants' subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP. Keywords: HIV/AIDS; integrated service model; treatment as prevention; structural vulnerability; qualitative; Canada, Introduction The negative impact of social-structural inequities, such as poverty, homelessness and drug criminalization on HIV treatment and care among people living with HIV (PLHIV) who use drugs is well [...]

Abstract Background HIV infection is a serious concern in the Canadian Aboriginal population, particularly among youth; however, there is limited attention to this issue in research literature. The purpose of this national study was to explore HIV testing and care decisions of Canadian Aboriginal youth. Methods A community-based mixed-method design incorporating the Aboriginal research principles of Ownership, Control, Access and Possession (OCAP) was used. Data were collected through surveys (n = 413) and qualitative interviews (n = 28). Eleven community-based organizations including urban Aboriginal AIDS service organizations and health and friendship centres in seven provinces and one territory assisted with the recruitment of youth (15 to 30 years). Results Average age of survey participants was 21.5 years (median = 21.0 years) and qualitative interview participants was 24.4 years (median = 24.0). Fifty-one percent of the survey respondents (210 of 413 youth) and 25 of 28 interview participants had been tested for HIV. The most common reason to seek testing was having sex without a condom (43.6%) or pregnancy (35.4%) while common reasons for not testing were the perception of being low HIV risk (45.3%) or not having had sex with an infected person (34.5%). Among interviewees, a contributing reason for not testing was feeling invulnerable. Most surveyed youth tested in the community in which they lived (86.5%) and 34.1% visited a physician for the test. The majority of surveyed youth (60.0%) had tested once or twice in the previous 2 years, however, about one-quarter had tested more than twice. Among the 26 surveyed youth who reported that they were HIV-positive, 6 (23.1%) had AIDS at the time of diagnosis. Delays in care-seeking after diagnosis varied from a few months to seven years from time of test. Conclusion It is encouraging that many youth who had tested for HIV did so based on a realistic self-assessment of HIV risk behaviours; however, for others, a feeling of invulnerability was a barrier to testing. For those who tested positive, there was often a delay in accessing health services.

Background HIV is increasingly experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed disability. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation. Methods We convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques. Results Ninety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy. Conclusions These priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada. [ABSTRACT FROM AUTHOR]

Background: People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as 'disability'. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV.Methods: We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2-0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis.Results: Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001).Conclusions: Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions. [ABSTRACT FROM AUTHOR]

Objective: To examine the type and frequency of living strategies used by adults living with HIV.Methods: We conducted a cross-sectional web-based survey that included 51 living strategies: maintaining sense of control, attitudes and beliefs, blocking HIV out of the mind, and social interaction. We examined the frequency of use and compared the proportion of respondents who engaged in strategies across 3 age-groups (<40 years, 40-49 years, and ≥50 years).Results: Of the 935 participants, the majority were men (79%) and most (≥60%) engaged "most" or "all of the time" in healthy lifestyle strategies and maintained a positive outlook living with HIV. Compared to younger participants, a higher proportion of older adults (≥50 years) engaged "most" or "all the time" in strategies that involved maintaining control over health and adopting positive attitudes and outlook living with HIV.Conclusions: Findings can help to inform the role of self-management to enhance successful aging with HIV. [ABSTRACT FROM AUTHOR]

Background: HIV increasingly is experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed 'disability'. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation.Methods: We convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques.Results: Ninety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy.Conclusions: These priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula., Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health., Methods: Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective., Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business., Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development., (© Swathi Ramachandran, Hsiu-Ju Chang, Catherine Worthington, Andre Kushniruk, Francisco Ibáñez-Carrasco, Hugh Davies, Geoffrey McKee, Adalsteinn Brown, Mark Gilbert, Ihoghosa Iyamu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: Digital testing services for sexually transmitted and blood-borne infections (STBBIs), such as GetCheckedOnline, experience significant user drop-offs. For example, 32% of GetCheckedOnline users needing testing at account creation do not test, constituting missed opportunities. We explored the influence of users' expectations and experiences of GetCheckedOnline's web design and implementation on missed opportunities., Methods: This interpretive description purposively sampled 14 GetCheckedOnline users who created accounts between April 2022 and February 2023, indicated needed testing at account creation but did not test. We conducted semi-structured interviews and cognitive walkthroughs of GetCheckedOnline on Zoom, exploring participants' expectations and experiences, including problems using the service. Interviews were audio recorded, transcribed verbatim, and analyzed using reflexive thematic analyses., Results: Three themes were identified: (a) transitioning between GetCheckedOnline and laboratory services is a major testing barrier; (b) users' appraisal of their health and social contexts is a determinant of testing through GetCheckedOnline; and (c) tailoring GetCheckedOnline's design and implementation to accommodate varying user needs can promote equitable testing. Health equity issues occurred along sociodemographic gradients as the GetCheckedOnline-laboratory transition was more onerous for older users. Users' appraisal of their testing needs which varied by age and gender, and their assessment of time, and travel requirements for testing in remote communities influenced testing. Learning about GetCheckedOnline from healthcare providers improved testing compared with learning about the service through Google search which raised trust concerns regarding GetCheckedOnline's authenticity. Suggested improvements to promote health equity include personalized education, mail-in testing options, and simpler seamless web experiences., Conclusions: To promote equitable access to digital STBBI testing services such as GetCheckedOnline, we can adapt web-design and implementation to suit user needs and contexts, ensuring simplicity and options for testing that reduce user burdens., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)