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

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 STI Check in the Emergency Room (STIckER), a user-informed digital patient decision aid aiming to increase shared decision making around genitourinary and extragenital STIs testing among AYA ED patients. Methods: This 2-center study followed a multiphase approach. In phase 1, we defined our health condition, target audience, and health decision, and organized a multidisciplinary steering group. Through a series of design workshops, we created a low-fidelity prototype. In phase 2, we conducted semistructured interviews with AYA ED patients and ED health care providers 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 19 AYA ED patients suggested interest in participating in the decision for STI testing and have emotions about getting results. Interviews with 15 ED health care providers highlighted that shared decision making 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 nonjudgmental 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.