Mixed offers/Mixed messages: Benefits and liabilities of offering more than one type of EPS

Background. Expedited STI healthcare service options promise to identify and treat more people, more efficiently, and more conveniently than traditional service delivery. Expedited partner services (EPS), including partner notification, screening, or treatment, are generally well-accepted, although a small proportion of consumers continually finds one or more EPS unacceptable. What is not well-established is the effect offering more than one of these services has on uptake. Methods. Through clinic-based interviews (n=40) and public intercept surveys (n=200), the effects of simultaneous, i.e. “a la carte,” and sequential service offers were investigated. Multivariate analysis examined uptake differences by offer types, participant roles, and participant characteristics. Qualitative analysis explored participants' acceptance/refusal rationales. Results. When presented simultaneously, the majority of participants selected PDPS/PDPT together. For sequential offers (PDPT->PDPS->partner notification->nothing), those accepting the first offer (PDPT) significantly exceeded those selecting only PDPT in the simultaneous condition and did not statistically differ from the overall number accepting PDPT or combined PDPT/PDPS. Individuals who refused the first offer frequently accepted the second (PDPS). Discussion. Multiple simultaneous EPS service offerings appear to lead to greater overall willingness to engage in at least one service; however, the temptation to simply add several expedited services to our toolkit and offer them all at once must be tempered by an understanding that for some patients and partners, offering multiple simultaneous options appears to lead to reduced uptake of what is arguably the key service: treatment. These findings align with consumer choice research and have important implications for EPS implementation and future research.