{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:05:10Z","timestamp":1782846310397,"version":"3.54.5"},"reference-count":38,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Digital sexually transmitted and blood-borne infection (STBBIs) testing services are used to improve testing access, but might replicate existing social inequities. Previous research has shown that the digital STBBI testing service\n GetCheckedOnline<\/jats:italic>\n has improved access to testing in British Columbia (BC), Canada. As part of the program\u2019s continuous evaluation, we examined awareness and use of the service in 5 urban, suburban, and rural communities where the program has expanded.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to determine if social location is associated with differences in awareness and use of the service in 5 communities outside Vancouver, BC.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n From July to September 2022, we conducted a cross-sectional survey recruiting (in-person and online) sexually active people aged 16 years or older in 5 urban, suburban, and rural communities where\n GetCheckedOnline<\/jats:italic>\n had sample collection sites available at the time. We examined differences in awareness and use by age, gender identity, sexual identity, race\/ethnicity, education, and income using logistic regression models informed by the Health Equity Measurement Framework.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 1658 participants (n=1058, 63.8% in-person and n=600, 36.2% online), 35.3% (586\/1658) were aware of\n GetCheckedOnline<\/jats:italic>\n and 19.5% (324\/1658) had used it. Awareness and use were lower in the first and last age quartiles compared to the second quartile (>38 years: awareness odds ratio [OR] 0.23, 95% CI 0.17\u20100.32; use OR 0.19, 95% CI 0.12\u20100.28; <25 years: awareness OR 0.39, 95% CI 0.28\u20100.53; use OR 0.28, 95% CI 0.18\u20100.41). Awareness and use were also lower in the lowest income group compared to the highest (awareness OR 0.39, 95% CI 0.24\u20100.65; use OR 0.36, 95% CI 0.20\u20100.65). Awareness and use were higher among genderfluid, genderqueer, and nonbinary participants compared to men (awareness OR 2.27, 95% CI 1.63\u20103.18; use OR 1.97, 95% CI 1.36\u20102.84), transgender compared to cisgender participants (awareness OR 2.17, 95% CI 1.54\u20103.06; use OR 2.15, 95% CI 0.46\u20103.13), and nonheterosexual compared to heterosexual participants (awareness OR 2.37, 95% CI 1.89\u20102.97; use OR 2.53, 95% CI 1.91\u20103.38). People of color had higher awareness and use vs White participants (awareness OR 1.74, 95% CI 1.34\u20102.26; use OR 2.01, 95% CI 1.48\u20102.72). Indigenous participants had higher awareness than White participants (OR 1.65, 95% CI 1.19\u20102.20) but no difference in use. Women had similar awareness but lower use compared to men (OR 0.68, 95% CI 0.50\u20100.92).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n GetCheckedOnline<\/jats:italic>\n is an equitable means of access to STBBI testing for some but not all equity-owed groups in BC. Further adaptations should consider factors such as differences in material circumstances to improve its accessibility for all.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/78561","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T19:00:08Z","timestamp":1771959608000},"page":"e78561-e78561","source":"Crossref","is-referenced-by-count":0,"title":["Health Equity Analysis of Awareness and Use of GetCheckedOnline, British Columbia\u2019s Digital Intervention for Sexually Transmitted and Blood-Borne Infection Testing in 5 Urban, Suburban, and Rural Communities: Cross-Sectional Survey Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5088-5051","authenticated-orcid":false,"given":"Rodrigo","family":"Sierra Rosales","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1436-6276","authenticated-orcid":false,"given":"Aidan","family":"Ablona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-2407","authenticated-orcid":false,"given":"Hsiu-Ju","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4955-1017","authenticated-orcid":false,"given":"Devon","family":"Haag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3019-7011","authenticated-orcid":false,"given":"Heather","family":"Pedersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3075-8229","authenticated-orcid":false,"given":"Catherine","family":"Worthington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-3959","authenticated-orcid":false,"given":"Daniel","family":"Grace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1464-1584","authenticated-orcid":false,"given":"Rod","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4860-384X","authenticated-orcid":false,"given":"Devon","family":"Greyson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5978-6843","authenticated-orcid":false,"given":"Mark","family":"Gilbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"issue":"11","key":"R1","doi-asserted-by":"publisher","first-page":"e155","DOI":"10.1097\/OLQ.0000000000001475","article-title":"Direct-to-consumer sexually transmitted infection testing services: a position statement from the American Sexually Transmitted Diseases Association","volume":"48","author":"Exten","journal-title":"Sexual Trans Dis"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7097","article-title":"Use of GetCheckedOnline, a comprehensive web-based testing service for sexually transmitted and blood-borne infections","volume":"19","author":"Gilbert","journal-title":"J Med Internet Res"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1136\/sextrans-2017-053325","article-title":"Differences in experiences of barriers to STI testing between clients of the internet-based diagnostic testing service GetCheckedOnline.com and an STI clinic in Vancouver, Canada","volume":"95","author":"Gilbert","journal-title":"Sex Transm Infect"},{"issue":"12","key":"R4","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1016\/j.puhe.2014.10.008","article-title":"Digital health interventions: widening access or widening inequalities?","volume":"128","author":"McAuley","journal-title":"Public Health (Fairfax)"},{"key":"R5","doi-asserted-by":"crossref","unstructured":"Lawrence K . Digital Health Equity. Exon Publications; 2022:121-130. [doi: 10.36255\/exon-publications-digital-health-health-equity]","DOI":"10.36255\/exon-publications-digital-health-health-equity"},{"issue":"18","key":"R6","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1001\/jama.2021.18459","article-title":"Focusing on digital health equity","volume":"326","author":"Lyles","journal-title":"JAMA"},{"issue":"8","key":"R7","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1136\/sextrans-2023-055749","article-title":"Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review","volume":"99","author":"Iyamu","journal-title":"Sex Transm Infect"},{"issue":"jul05 1","key":"R8","doi-asserted-by":"publisher","first-page":"e4316","DOI":"10.1136\/bmj.e4316","article-title":"Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation","volume":"345","author":"van den Broek","journal-title":"BMJ"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/sextrans-2017-053302","article-title":"Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis","volume":"94","author":"Barnard","journal-title":"Sex Transm Infect"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-10-293","article-title":"Rationale, design, and results of the first screening round of a comprehensive, register-based, chlamydia screening implementation programme in the Netherlands","volume":"10","author":"van Bergen","journal-title":"BMC Infect Dis"},{"issue":"7","key":"R11","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1136\/sextrans-2019-054071","article-title":"A cohort study comparing rate of repeat testing for sexually transmitted and blood-borne infections between clients of an internet-based testing programme and of sexually transmitted infection clinics in Vancouver, Canada","volume":"95","author":"Gilbert","journal-title":"Sex Transm Infect"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2019.05.003","article-title":"Recruiting vulnerable populations to participate in HIV prevention research: findings from the Together 5000 cohort study","volume":"35","author":"Grov","journal-title":"Ann Epidemiol"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1016\/j.amepre.2021.06.009","article-title":"A pilot of mail-out HIV and sexually transmitted infection testing in Washington, District of Columbia during the COVID-19 pandemic","volume":"61","author":"Fistonich","journal-title":"Am J Prev Med"},{"issue":"6","key":"R14","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1177\/2325957416668579","article-title":"Factors associated with returning at-home specimen collection kits for HIV testing among internet-using men who have sex with men","volume":"15","author":"Ricca","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.amepre.2010.11.019","article-title":"Using mass media and the internet as tools to diagnose hepatitis C infections in the general population","volume":"40","author":"Zuure","journal-title":"Am J Prev Med"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1136\/sextrans-2011-050455","article-title":"High yield of reinfections by home-based automatic rescreening of Chlamydia positives in a large-scale register-based screening programme and determinants of repeat infections","volume":"89","author":"G\u00f6tz","journal-title":"Sex Transm Infect"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/OLQ.0b013e3182383097","article-title":"Who participates in the Dutch Chlamydia screening? A study on demographic and behavioral correlates of participation and positivity","volume":"39","author":"Op de Coul","journal-title":"Sex Transm Dis"},{"issue":"S5","key":"R18","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25118","article-title":"What would you choose: online or offline or mixed services? Feasibility of online HIV counselling and testing among Thai men who have sex with men and transgender women and factors associated with service uptake","volume":"21","author":"Phanuphak","journal-title":"J Intern AIDS Soc"},{"issue":"10","key":"R19","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1177\/0956462420982830","article-title":"Beyond the binary: sexual health outcomes of transgender and non-binary service users of an online sexual health service","volume":"32","author":"Day","journal-title":"Int J STD AIDS"},{"issue":"7","key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/14230","article-title":"Using digital communication technology to increase HIV testing among men who have sex with men and transgender women: systematic review and meta-analysis","volume":"22","author":"Veronese","journal-title":"J Med Internet Res"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","journal-title":"Adm Policy Ment Health"},{"issue":"4","key":"R22","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1136\/sextrans-2023-056007","article-title":"Reach of GetCheckedOnline among gay, bisexual, transgender and queer men and two-spirit people and correlates of use 5 years after program launch in British Columbia, Canada","volume":"100","author":"Montiel","journal-title":"Sex Transm Infect"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s12939-019-0935-0","article-title":"The health equity measurement framework: a comprehensive model to measure social inequities in health","volume":"18","author":"Dover","journal-title":"Int J Equity Health"},{"key":"R24","unstructured":"World Health Organization. Global report on ageism. 2021. URL: https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1336324\/retrieve [Accessed 22-02-2023]"},{"issue":"8016","key":"R25","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1038\/d41586-024-01719-9","article-title":"Beyond the trans\/cis binary: introducing new terms will enrich gender research","volume":"630","author":"Ashley","journal-title":"Nature New Biol"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyw341","article-title":"Robust causal inference using directed acyclic graphs: the R package \u2018DAGitty\u2019","author":"Textor","journal-title":"Int J Epidemiol"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1146\/annurev-publhealth-031914-122559","article-title":"Statistical foundations for model-based adjustments","volume":"36","author":"Greenland","journal-title":"Annu Rev Public Health"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1093\/aje\/kws412","article-title":"The table 2 fallacy: presenting and interpreting confounder and modifier coefficients","volume":"177","author":"Westreich","journal-title":"Am J Epidemiol"},{"issue":"43","key":"R29","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham","journal-title":"JOSS"},{"key":"R30","unstructured":"R Core Team. R: a language and environment for statistical computing. URL: https:\/\/www.R-project.org\/ [Accessed 19-03-2026]"},{"key":"R31","unstructured":"Rogers EM . Diffusion of Innovations. Free Press; 2003. URL: http:\/\/ebookcentral.proquest.com\/lib\/ubc\/detail.action?docID=4935198 [Accessed 21-06-2023]"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1136\/sextrans-2018-053645","article-title":"Qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who use GetCheckedOnline.com: a comprehensive internet-based diagnostic service for HIV and other STIs","volume":"95","author":"Knight","journal-title":"Sex Transm Infect"},{"issue":"11","key":"R33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0277315","article-title":"Cisnormativity as a structural barrier to STI testing for trans masculine, two-spirit, and non-binary people who are gay, bisexual, or have sex with men","volume":"17","author":"Stewart","journal-title":"PLoS ONE"},{"issue":"12","key":"R34","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.1093\/jamia\/ocac142","article-title":"Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out","volume":"29","author":"Apodaca","journal-title":"J Am Med Inform Assoc"},{"key":"R35","unstructured":"Farrell J Haag D Bondyra M Thomson K Gilbert M . Should your visuals be wearing blue, pink or yellow pants (or no pants at all)? Developing specimen self-collection instructions that are more sensitive to the needs of traditionally marginalized and underserved client populations. Presented at: Gay & Lesbian Medical Association 33rd Annual Conference; Oct 17-20, 2015; Atlanta, Georgia, USA. 2015."},{"issue":"1","key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/11291","article-title":"Assessing the impact of a social marketing campaign on program outcomes for users of an internet-based testing service for sexually transmitted and blood-borne infections: observational study","volume":"21","author":"Gilbert","journal-title":"J Med Internet Res"},{"key":"R37","unstructured":"Loppie S Reading C de Leeuw S . Indigenous experiences with racism and its impacts. National Collaborating Centre for Aboriginal Health. 2014."},{"key":"R38","unstructured":"Bernroider L Miro Born A Kulz C Gang SU . Introduction: exploring urban violence and inequality from intersectional perspectives. In: Intersectionality and the City. Routledge;"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e78561","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:11:15Z","timestamp":1782843075000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e78561"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":38,"URL":"https:\/\/doi.org\/10.2196\/78561","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"article-number":"v28i11e78561"}}