Table 3.

Potential harms and mitigation strategies recommended by sexual health care providers, and how these were addressed in the design of GetCheckedOnline.

Potential harm	Recommended mitigation strategy	How addressed
Anxiety related to viewing email notification or retrieving voicemail (if positive) outside of clinic hours	Provide after-hours support, send notifications early in the day Notification emails should be generic and not include results	Links to BCCDCa sexual health website and provincial after-hours support services Generic wording used for notification emails
Not addressing underlying anxiety of repeat tests by the “worried well”	Ability to monitor and intervene if appropriate (eg, refer to clinic for care)	Monitored during the pilot evaluation Clinic protocol developed to handle this scenario
Misunderstanding information on the website, such as window periods, symptoms	Ensure appropriate educational content on website related to test limitations and symptoms	Information accessible throughout the site related to test limitations and window periods Links to British Columbia Centre for Disease Control sexual health website for more information about symptoms
Inadequate pre- and posttest counseling	Provide equivalent information on website, with some mandatory information Include clear consent process and disclaimer regarding limitations of Web-based testing	Content from provincial pre/posttest guidelines incorporated, with mandatory and optional content Consent page including acknowledgement of limitations as final step before printing requisition
Missed opportunities for education and prevention that can be elicited during clinical testing encounters	Include information and referrals for pap testing, human papilloma virus vaccine	Tailored recommendations for sexually transmitted and blood-borne infections prevention provided based on assessment responses, including vaccines, oral and rectal swabs, emergency contraception, HIV postexposure prophylaxis
Does not include all potentially relevant tests (eg, Hepatitis C, swabs)	Include Hepatitis C testing Have clear referrals to clinics for other tests On assessment include question about specific sexual acts (oral, vaginal, anal) and recommend swabs if appropriate Explain why certain tests are not offered	Hepatitis C testing included for men who have sex with men, or history of injection drug use Swabs prioritized for inclusion after implementation
Not answering assessment questions accurately and inappropriate tests recommended (or not)	Give option to skip assessment and recommend all tests Encourage clients to provide accurate information (through disclaimer, encourage to select “prefer not to answer” option)	Importance of providing accurate information emphasized Clients have option of deselecting any recommended tests
Positive results not followed up because of client providing fake contact information	Encourage use of real name and phone number	Importance of using real name or consistent pseudonym, and providing telephone number emphasized

^aBCCDC: British Columbia Centre for Disease Control.