Background: Cultural competency has been identified as a barrier to lesbian, gay, bisexual and transgender (LGBT) populations seeking care. Mystery shopping has been widely employed in the formal health care sector as a quality improvement (QI) tool to address specific client needs. The approach has had limited use in community-based organizations (CBO) due in part to lack of knowledge and resource requirement concerns.
Several mystery shopping initiatives are now being implemented which focus on the LGBT population with the goal of reducing barriers to accessing care. One subset targets men who have sex with men (MSM) to increase uptake of HIV testing. No intervention investigates costs of these initiatives, a key aspect of sustainability.
The Get Connected randomized control trial used peer-led, high intensity, mystery shopping to identify and help develop culturally competent HIV testing sites for young men who have sex with men (YMSM) in high incidence urban areas. Mystery shopping modelled use of centralized CBO, such as a public health department (PHD), to spearhead shopping in community clinics. Our objective was to determine the resource requirements and costs of using high-intensity, peer mystery initiated in the trial to inform sustainability.
Methods: Through consultation with study staff, we identify a resource inventory for undertaking a mystery shopping program. We used activity-based costing to price each of the resource inputs. We classified costs as start-up and on-going implementation costs. We calculated costs for each category, total costs and cost per mystery shopper visit for the four-month trial and annually to reflect standard budgeting periods.
Results: Recruitment and training of peer mystery shoppers were the most expensive tasks. Average start-up costs were $10,001 (SD $38,8). Four-month average implementation costs per visit were $228 (SD $1.97). Average annual implementation costs per visit were 33% lower at $151 (SD $5.60).
Conclusions: Peer-led, mystery shopping of HIV-testing sites is feasible, and is likely affordable for medium to large public health departments.