Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 9, 2024
Date Accepted: Jan 31, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Use of the RE-AIM framework to assess a digital health tool designed to improve low sexual desire in women: An implementation science study
ABSTRACT
Background:
Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While Cognitive-Behavioral Therapy (CBT) and Mindfulness-Based Therapy (MBT) are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers CBT and MBT skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious.
Objective:
The goal of the present implementation science study was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance of implementation) framework to assess the integration of eSense into a number of sexual health clinics.
Methods:
A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on wait-lists to receive sex therapy or sexual medicine care.
Results:
All aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics with the caveat that half of the clinics noted cost as a key issue for future implementation, and one third noted that the administrative burden of implementing eSense as a standard of care may be challenging. At the end-user level, the majority expressed a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes, and a high level of satisfaction with eSense.
Conclusions:
eSense is an effective digital health tool for addressing female sexual dysfunction that shows moderate evidence of implementation effectiveness. Future studies should address the barriers identified if this tool is to be implemented in clinical settings. Clinical Trial: The procedures were registered at ClinicalTrials.gov NCT05168371 and Open Science Framework (https://osf.io/szbnc/). Data and code will be available after publication.
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