Background We assessed associations between web-design/implementation factors and missed opportunities to provide testing via GetCheckedOnline and assessed if these associations were modified by sociodemographic factors.

Methods A cross-sectional survey was conducted in November and December 2022 among clients who indicated needing testing when they created accounts between April and October 2022. Web-design (user interface and experience) and implementation (organization of clinical services around the website) factors were independently modelled against missed opportunities (self-reported inability/unwillingness to test despite needing testing at account creation) using multivariable logistic regression. Effect modification by sociodemographic factors were also conducted.

Results Among 572 respondents needing testing at account creation, 183 (32.0%, 95%CI: 28.18-35.99%) experienced missed opportunities. Web-design factors associated with missed opportunities were difficulty using GetCheckedOnline’s website (adjusted odds ratio (aOR) 3.40, 95%CI:1.68-6.87), while implementation factors were difficulty getting to a laboratory (aOR:3.26, 95%CI:1.97-5.41); perceived inadequacy of tests offered through GetCheckedOnline (aOR:1.81, 95%CI:1.11-2.95) and being likely to complete testing if self-sampling was available (aOR:2.12, 95%CI:1.32-3.42). Findings were consistent in sensitivity analyses but concerns about privacy and security of personal information on GetCheckedOnline (aOR:1.93, 95%CI:1.11-3.35) was associated with missed opportunities. Sociodemographic factors modified associations as respondents with annual income < $20,000CAD, not employed full-time, immigrants, men (who did not agree GetCheckedOnline offered all needed tests) and women (who experienced difficulties getting to a laboratory) had higher odds missed opportunities.

Conclusions Simplifying web-design, ensuring optimal client education, and including more laboratory locations and self-sampling as options for testing, could reduce missed opportunities and promote equitable access to GetCheckedOnline.

Author Summary Digital health interventions like GetCheckedOnline aim to improve access to testing for sexually transmitted and blood-borne infections (STBBIs), but barriers related to web design and service implementation can limit their impact. Our study, based on a 2022 client experience survey, examined how these factors contribute to missed opportunities for testing among GetCheckedOnline users in British Columbia, Canada. We found that 32% of users who created accounts intending to test, reported not testing through the service. They reported barriers including difficulty navigating the website, accessing laboratories, and concerns about the adequacy of available tests. Importantly, these barriers varied across sociodemographic groups, with individuals with lower incomes, immigrants, and women facing the greatest challenges. Our findings suggest that simplifying website navigation, expanding laboratory access, and introducing self-sampling options could reduce missed opportunities and improve equitable access to digital STBBI testing. These insights highlight the need for ongoing, data-driven optimizations to ensure digital health services effectively reach those who face the greatest barriers to care.

The authors have declared no competing interest.

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Ethics approval was obtained from the University of British Columbia’s Behavioral Ethics Board (ethics #H18-00437).

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