The development and deployment of an interactive digital health intervention to aid diagnosis and management of sexual dysfunction problems and underlying cardiovascular disease

Problem

The uptake of health screenings remains low, especially in men (NHS Health Check Programme, 2017) and with stigmatised conditions. Technology is employed to increase uptake and improve patient empowerment. We aimed to create a digital health intervention (DHI: mobile App and web-based application) which acts as triage tool and allows (timely) detection of sexual dysfunction problems and potentially underlying cardiovascular disease (CVD) and metabolic problems, thereby providing an opportunity for intervention in primary care.

Approach

Diagnostic and management criteria for female sexual and erectile dysfunction, premature ejaculation, testosterone deficiency (low libido) and lower urinary tract symptoms (LUTS) were obtained from international guidelines to create an App/website where users access validated questionnaires. Interviews with groups of stakeholders were conducted to develop and refine the DHI.

Findings

User data (N = 21,846) from March 2016-December 2019 suggested high levels of sexual dysfunction amenable to treatment. Regarding the erectile dysfunction (N= 6533, mean age 67y, SD = 22y) and the premature ejaculation tests (N= 1834, mean age 34y, SD = 14y), 77% and 87% of participants respectively portrayed some dysfunction. Regarding testosterone levels, 47 % (N= 4214, mean age 56y, SD = 16y) produced a score that warranted further investigations. Only 33% of all participants (N= 8955, mean age 30y, SD = 8y) undertaking the female sexual dysfunction questionnaire reported normal function. Similarly, 33% of females (N= 190, mean age 29y, SD= 12y) and 28% of males (N= 120, mean age 49 years, SD = 18y) reported normal urination.

Consequences

This is the first DHI supporting health screening and management advice for the above conditions. Benefits include easy access, privacy, it is cost free, has a triage tool function, and provides a preliminary diagnosis and management support. The acceptability and usability of the web application was higher than that of the App thereby allowing to draw in a wider age range. Given that, for example, erectile dysfunction is a predictor and independent risk factor of CVD and has recently been incorporated into cardiovascular risk calculators (QRisk 3; Hackett & Kirby, 2017), this tool may aid diagnosis of (early) CVD and metabolic problems, thereby providing a window of opportunity for lifestyle changes/pharmacological management.