Self-directed sexually transmitted infection testing: providing noninvasive sexual health services Patrick O'Byrne, RN, PhD ⁎ Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada K1H 8M5 Received 3 November 2008; revised 6 January 2009; accepted 4 February 2009 Abstract A literature review that addressed the possible reasons sexually transmitted infection (STI) rates are increasing indicated that self-directed STI testing for gonorrhea and chlamydia should be trialed. As such, a self-directed STI testing kit was developed and piloted for 6 months, during which 182 bathhouse patrons accessed services from both an on-site nurse and through the self- directed kits. In total, 127 of these individuals presented for testing from the nurse, with the remaining using the self-directed testing kits. Community/Participant feedback indicated that this testing method was a welcome adjunct to traditional services, thus suggesting that self-directed testing should be further explored. © 2011 Elsevier Inc. All rights reserved. 1. Introduction Over the last decade, gonorrhea rates have remained relatively stable across Canada (PHAC, 2006), but despite both population-based and individually targeted interven- tions, the incidence rate for chlamydia infections, syphilis, and HIV has increased (PHAC, 2006). In efforts to ameliorate these rates, most research, to date, has focused on enhanced public health surveillance strategies and on improved behavioral correlates of individuals who test positive for these infections. On a much smaller scale, other research has been exploring alternative methods to address these rates and has indicated that one important factor is that some individuals resist sexually transmitted infection (STI) testing due to their perceptions of sexual health services as being highly embarrassing and invasive (Hogben et al., 2004; Holmes & O'Byrne, 2006; Malta et al., 2007; O'Byrne & Holmes, 2005). Fortunately, the advent of the United States-based BD ProbeTec Urine Preservation Transport Kit (BD, 2007) allowed the author to build on this research and target these individuals who resist face-to-face STI testing services by developing a self-directed STI testing kit. In this article, I will provide a transparent overview of a nearly 2-year-long process that culminated in the development and implementa- tion of self-directed gonorrhea and chlamydia testing pilot project that took place within two Canadian bathhouses. To accomplish this, the findings of the literature review and the theoretical exploration are outlined, and then a brief overview of some results of a self-directed STI testing pilot project is provided (for in-depth details on these results, see O'Byrne & Dias, 2008), followed by a presentation of the clinical implications of these findings for public health officials. 2. Background 2.1. Step 1—literature review The first step in the development of the self-directed STI testing kit was the review of existing literature, which was undertaken using the CIHNAL, EMBASE, MEDLINE, and HealthSTAR databases (no language or date restrictions). The search terms urine, testing, and sexually transmitted infections were employed. In total, 33 articles were found. After a full-article review, 11 were discarded as nonrelevant, and 22 remained. The 11 discarded articles discussed methods of urine STI testing but had no relevance to self- directed testing. Of the 22 remaining articles, 7 described a high degree of self-reported acceptance for self-directed STI Available online at www.sciencedirect.com Applied Nursing Research 24 (2011) 17 – 21 www.elsevier.com/locate/apnr ⁎ Fax: +1 613 562 5443. E-mail address: pjobyrne@uottawa.ca. 0897-1897/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.apnr.2009.02.005