The Design Process of a Digital Patient Decision Tool to Increase Sexually Transmitted Infection Testing in the Emergency Department

Abstract Background Adolescents and young adults (AYA) frequently use the emergency department (ED) and admit to infrequent contraceptive use, increasing their risk of sexually transmitted infections (STIs). This study aimed to design STIckER (STI Check in the ER), a user-informed digital patient decision aid aiming to increase shared decision-making (SDM) around genitourinary and extra-genital STIs testing among AYA ED patients. Methods This two-center study followed a multi-phased approach. In phase 1, we defined our health condition, target audience, and health decision, and organized a multi-disciplinary steering group. Through a series of design workshops, we created a low-fidelity prototype. In phase 2, we conducted semi-structured interviews with AYA ED patients and ED healthcare providers (HCPs) to understand values and preferences around STI testing and decision-aid implementation. Interviews were recorded and analyzed using rapid qualitative analysis techniques. Data from interviews led to a final high-fidelity prototype. Results Interviews with 20 AYA ED patients suggested interest in participating in the decision for STI testing and have emotions about getting results. Interviews with 15 ED HCPs highlighted that SDM matches clinical practice, interventions should not increase cognitive load, and sexual health interventions are more complex when parents are involved. Both groups were receptive to non-judgmental sexual health interventions that promote privacy and eliminate testing stigma. Conclusion The STIckER decision aid was designed using an iterative process that involved user testing and integrating feedback, leading to a digital tool that could promote equitable STI testing built specifically for the complex ED setting.