Emer O'Connell

Young women's decisions to accept chlamydia screening: influences of stigma and doctor- patient interactions

BackgroundAn understanding of the factors that encourage young women to accept, and discourage them from accepting, STI (sexually transmitted infection) testing is needed to underpin opportunistic screening programs for the STI Chlamydia trachomatis (opportunistic screening involves healthcare professionals offering chlamydia tests to people while they are attending health services for reasons that are usually unrelated to their sexual health). We conducted a qualitative study to identify and explore: how young women would feel about being offered opportunistic tests for chlamydia?; how young women would like to be offered screening, and who they wanted to be offered screening by?; and what factors would influence young womens partner notification preferences for chlamydia (who they would notify in the event of a positive diagnosis of chlamydia, how they would want to do this).MethodsSemi-structured interviews with 35 young women between eighteen and twenty nine years of age. The study was conducted in the Dublin and Galway regions of the Republic of Ireland. Young adults were recruited from General Practice (GP) practices, Third Level College health services, Family Planning clinics and specialist STI treatment services.ResultsRespondents were worried that their identities would become stigmatised if they accepted screening. Younger respondents and those from lower socio-economic backgrounds had the greatest stigma-related concerns. Most respondents indicated that they would accept screening if it was offered to them, however; accepting screening was seen as a correct, responsible action to engage in. Respondents wanted to be offered screening by younger female healthcare professionals. Respondents were willing to inform their current partners about positive chlamydia diagnoses, but were more ambivalent about informing their previous partners.ConclusionsIf an effort is not put into reducing young womens stigma-related concerns the population coverage of Chlamydia screening might be reduced.

Why don't young women go for Chlamydia testing? A qualitative study employing Goffman's stigma framework

Many women who might be at risk of having the sexually transmitted infection (STI) Chlamydia trachomatis either delay going, or do not go, for testing. We aimed to examine the factors that either prevent or discourage Irish young women from going for Chlamydia testing. We conducted in-depth interviews with 35 women in the Republic of Ireland who were between 18 and 29 years of age. Accounts were analysed using Goffmans stigma framework. Study respondents strongly associated Chlamydia and Chlamydia testing with stigma and felt that only irresponsible, promiscuous risk takers were at risk of contracting the infection. Respondents saw themselves as responsible, moral actors who avoided risk and took good care of their bodies; they were therefore not at risk of having Chlamydia. Going for Chlamydia testing was seen as a risky activity that could shift respondents identities into a negative ‘Other’ category. Respondents feared that if they found themselves in this ‘Other’ category they would open themselves to bullying and ostracism. While a negative act from a medical perspective, for respondents the act of not testing was seen as a positive activity that helped to reinforce their identities as good, ‘worthy’ individuals and avoided negative social consequences that might otherwise arise from the testing process.

The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland

Objective The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. Methods Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves. Results The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94 717. For cost-effectiveness threshold values of €45 000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%. Conclusions An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.

Chlamydia trachomatis infection and sexual behaviour among female students attending higher education in the Republic of Ireland

BackgroundThere are no prevalence data on Chlamydia trachomatis relating to female students attending higher education available for the Republic of Ireland. This information is required to guide on the necessity for Chlamydia screening programmes in higher education settings. This research aimed to determine the prevalence of and predictive risk factors for Chlamydia trachomatis genital infection among female higher education students in Ireland.MethodsAll females presenting during one-day periods at Student Health Units in three higher education institutions in two cities in the Republic of Ireland were invited to participate. Participants completed a questionnaire on lifestyle and socio-demographic factors and provided a urine sample. Samples were tested for C. trachomatis DNA by a PCR based technique (Cobas Amplicor, Roche). To examine possible associations between a positive test and demographic and lifestyle risk factors, a univariate analysis was performed. All associations with a p value < 0.05 were included in a multivariate logistic regression analysis.ResultsOf the 460 sexually active participants 22 tested positive (prevalence 4.8%; 95% CI 3.0 to 7.1%). Variables associated with significantly increased risk were current suggestive symptoms, two or more one-night stands and three or more lifetime sexual partners. The students displayed high-risk sexual behaviour.ConclusionThe prevalence of C. trachomatis infection and the lack of awareness of the significance of suggestive symptoms among sexually experienced female students demonstrate the need for a programme to test asymptomatic or non-presenting higher education students. The risk factors identified by multivariate analysis may be useful in identifying those who are most likely to benefit from screening. Alcohol abuse, condom use, sexual behaviour (at home and abroad) and, knowledge of sexually transmitted infections (STIs) (including asymptomatic nature or relevant symptoms) were identified as target areas for health promotion strategies. These strategies are needed in view of the high-risk sexual activity identified.

Men's attitudes towards chlamydia screening: a narrative review

OBJECTIVES Chlamydia trachomatis is a sexually transmissible infection (STI) that affects significant numbers of men. Research on mens perspectives on chlamydia screening (or testing) has been limited. We conducted a narrative review to examine: (1) what factors encourage or discourage men from attending health services for chlamydia screening, and/or from accepting screening once it has been offered to them, and (2) where men want chlamydia screening services to be located. METHODS A narrative review of the recent peer-reviewed literature (published between 1999 and 2009) on mens attitudes towards chlamydia screening. To be included, articles had to explore mens perspectives on screening (which could be ascertained through quantitative or qualitative studies, or from relevant discussion papers or reviews). RESULTS Forty-eight articles were included in all. Mens attitudes towards chlamydia screening are influenced by their knowledge about the infection, their perceived vulnerability to the infection, the degree of embarrassment and shame that they associate with screening and the stigma that they associate with screening. Men prefer to be offered urine testing for chlamydia. Men want to be offered screening by non-judgemental professionals. Mens attitudes towards screening for chlamydia in general practice, genito-urinary medicine clinics, home and outreach settings are also explored in this review. CONCLUSIONS Several factors influence mens attitudes towards screening. Two central themes underlie and influence many of these factors: mens needs to make positive impressions on others, and mens identification with particular ideals of masculinity. The review concludes with suggestions for future research on this topic.

Young adults' preferred options for receiving chlamydia screening test results: a cross-sectional survey of 6085 young adults

Summary We investigated how young adults aged 18-29 years would like to be notified of chlamydia screening test results, and, when they test positive, their willingness and preferred mechanism for informing their partners. We conducted a cross-sectional survey of 6085 young adults and found that a call to their mobile phone was their preferred way of receiving positive test results (selected by 50%), followed by email. Text messages (short message service [SMS]) and calls to landline phones were unpopular options, selected by between 5 and 10%. Over 75% of respondents stated they would inform their current partner of a positive chlamydia diagnosis, and 50% would inform their previous partners. Most were willing to receive yearly reminders to go for a chlamydia test. Young adults preference for being informed of chlamydia test results by mobile phone call, rather than by email or SMS text, especially if they test positive, suggests they place high value on the security of the communication mechanism. Offering a range of mechanisms for receipt of test results may increase the acceptability and coverage of sexually transmitted infection (STI) control strategies.

Where do young adults want opportunistic chlamydia screening services to be located

BACKGROUND This study measured the acceptability of urine-based chlamydia screening to young adults, where young adults wanted opportunistic chlamydia screening services to be located, and by whom they wanted to be offered screening. METHODS A cross-sectional survey of 5685 university students and 400 young adult healthcares setting attendees (age: 18-29 years). RESULTS Ninety-six percent of males and 93% of females said that they would find it acceptable to be offered chlamydia screening. Seventy-six percent of males and 77% of females wanted to be offered screening by a doctor or nurse. Young women would prefer female staff. Most respondents preferred that screening be located in traditional healthcare settings such as General Practices, and offered by either doctors or nurses. More than 90% of respondents did not want screening services to be located in pharmacies and almost all rejected public non-health care screening settings. CONCLUSIONS Opportunistic chlamydia screening services should be located in traditional healthcare/medical settings, and screening should be offered by doctors and nurses.