The acceptability, appropriateness, and equity of remote consultations in sexual and reproductive health services in England and Wales: a qualitative study

BackgroundRemote consultations (via telephone or video) were critical during COVID-19 restrictions for Sexual and Reproductive Health Services (SRHS) in England and Wales and continue to be implemented widely. However, there remains limited evidence on their impact on outcomes and health inequalities. This study, guided by the Framework for Digital Health Equity, explores the equity implications of remote sexual health consultations in England and Wales, examining their acceptability and appropriateness. MethodsWe conducted semi-structured interviews with 54 service users and potential service users and 35 professional stakeholders across three diverse case study areas. Participants were purposively sampled to ensure diversity in socio-demographic profile and service experience. All participants provided informed consent, and ethical approval for the study was granted by NHS Research Ethics Committee (REC: 23/NS/0128). Data were thematically analysed into narrative themes, with findings interpreted collaboratively with public and patient involvement groups. ResultsThe study found that remote consultations have reshaped care delivery, improving efficiency but also generating additional clinical workload and, for some clinicians, reduced job satisfaction. While generally acceptable, remote models were perceived to affect rapport, extend care pathways for some service users, and impact privacy and safeguarding. We found the benefits of remote consultation are unevenly distributed, with those experiencing digital exclusion, who lack access to suitable private spaces, or who experience language barriers, being less able to take advantage of their convenience. ConclusionsRemote consultations transform SRHS delivery, improving efficiency for some but introducing challenges by impacting interaction, equity, and confidentiality. Benefits and burdens are unevenly distributed, reflecting structural, social, and individual factors influencing access. SRHS must ensure equitable access to appropriate care for all populations when implementing remote consultations. The findings show that a one-size-fits-all approach is not appropriate, and that giving service users choice in how they consult, including in-person, is important.