Designing for Scale and Sustainability in Digital STBBI Testing: A Theory-Informed Program Description and Adaptation Planning for GetCheckedOnline in British Columbia, Canada
This paper outlines a theory-informed framework for scaling and sustaining the GetCheckedOnline digital STBBI testing program in British Columbia by identifying seven essential core functions and mapping adaptable delivery forms to ensure equitable, context-sensitive implementation.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine GetCheckedOnline as a highly efficient, digital "drive-thru" for sexual health testing in British Columbia. Instead of waiting in a doctor's office, people can log onto a website, answer some questions about their health risks, get a digital prescription for a lab test, drop off their sample at a partner lab, and get their results back online—all without ever seeing a nurse or doctor in person.
This paper is essentially a blueprint for remodeling and expanding that drive-thru so it can handle more cars, reach more neighborhoods, and keep running smoothly for years to come, without losing the special features that make it work so well in the first place.
Here is how the authors break it down, using simple analogies:
1. The Big Problem: "The House That Got Too Big"
The program started in 2014 and has been very successful. However, like a popular family restaurant that suddenly needs to open locations in every town, the original "recipe" might not work everywhere. Some people live in rural areas where there are no partner labs, or they can't take time off work to visit a lab during business hours.
The authors wanted to figure out: What parts of the restaurant must stay exactly the same to keep the food tasting right (Core Functions), and what parts can we change to fit different neighborhoods (Possible Forms)?
2. The Toolkit: "The Core vs. The Decor"
To solve this, the researchers used a special planning tool (a framework) that separates a program into two buckets:
- Core Functions (The Engine): These are the non-negotiable parts. If you remove these, the car stops working.
- Possible Forms (The Body Style): These are the adaptable parts. You can swap a sedan for a truck, or paint it red instead of blue, as long as the engine stays the same.
3. The Three "Engines" They Identified
The team found seven essential "engines" (Core Functions) grouped into three main categories that must be preserved:
A. The "Open Door" Engine (Reducing Barriers)
- The Goal: Make it incredibly easy for anyone to get tested, especially those who feel shy, busy, or have had bad experiences with doctors.
- What stays the same: The ability to start the process yourself without needing a doctor's appointment first.
- What can change (The "Body Style"): Right now, you have to go to a specific lab to drop off your sample. The paper suggests that in the future, we could adapt this by using mail-in kits (like ordering a pizza to your door), mobile labs (a van that comes to you), or community kiosks (like a vending machine in a trusted community center).
B. The "Trust Vault" Engine (Privacy & Autonomy)
- The Goal: Make users feel safe, private, and in control. Many people won't use the service if they fear their name will be leaked or if they feel judged.
- What stays the same: The system must allow people to stay anonymous (or use a fake name) if they want to, and they must be able to choose when and how they get tested.
- What can change: Currently, you log in with an email and password. In the future, the "body style" could change to include tiered identity options (where you can choose to be fully anonymous, semi-anonymous, or fully named depending on your comfort level) or multilingual dashboards to help people who speak different languages.
C. The "Safety Net" Engine (Continuity of Care)
- The Goal: If someone tests positive, the system must immediately connect them to treatment so they don't fall through the cracks.
- What stays the same: There must be a clear, fast path from "I have a result" to "I am getting treatment."
- What can change: Right now, a nurse at the central health office calls you. In the future, this could be adapted to telehealth video calls, automated text messages that link you to a local pharmacy, or electronic prescriptions sent directly to a doctor near you.
4. The "Menu" of Future Options
The paper doesn't just say "we should change things." It lists specific, creative ways to adapt the program while keeping those three engines running:
- Instead of just labs: Use mail-in kits or self-testing kits that people can do at home.
- Instead of just online: Use phone support for people who aren't good with computers, or community partners to hand out test kits.
- Instead of just one way to log in: Offer different levels of privacy so people can choose what feels safest for them.
5. The Bottom Line
The authors conclude that if GetCheckedOnline wants to grow and last for the long haul, it needs to stop trying to be one rigid thing. It needs to be a chameleon.
Think of it like a Swiss Army Knife. The blade (the core function of providing safe, private testing) must always be sharp and reliable. But the handle (how you get the test, how you get results, where you drop it off) can change shape depending on whether you are in a busy city, a remote village, or a community with different needs.
By clearly separating the "must-haves" from the "could-haves," the program can expand to help more people without breaking the trust and safety that made it successful in the first place.
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