Katie Newby

How do young adults perceive the risk of chlamydia infection? A qualitative study

OBJECTIVES This study aimed to improve understanding of how young UK genito-urinary medicine (GUM) patients perceive the risk of chlamydia, and identify implications for health education. DESIGN A qualitative methodology was chosen. METHODS Semi-structured interviews with 27 respondents aged 16-22 years old were conducted. Data were subjected to thematic analysis. RESULTS Respondents made assessments of the perceived seriousness of, and their personal susceptibility to, chlamydia infection. Judgements about seriousness were related to beliefs about the controllability of symptoms and the long-term health consequences of infection. Susceptibility estimates were related to beliefs about the extent to which personal exposure put them in contact with chlamydia, and about the prevalence of infection amongst their peer group. This is consistent with the content of illness risk representations proposed by Cameron (2003). Respondents demonstrated some beliefs, which appeared to influence perceptions of seriousness and susceptibility in unhelpful ways. CONCLUSIONS Young people may be underestimating their risk of chlamydia infection due to the presence of unhelpful beliefs. Dialogue between health professionals and patients within GUM clinics, or through consultations as part of the National Chlamydia Screening Programme (NCSP), could provide vehicles to deliver health education to target these. Suggested health education includes highlighting false reassurance provided by treatment beliefs and exposing the fallibility of using overt characteristics to judge the likelihood that a potential sexual partner poses a risk of infection.

Which outcome expectancies are important in determining young adults' intentions to use condoms with casual sexual partners?: a cross- sectional study

BackgroundThe prevalence of unwanted pregnancy and sexually transmitted infection amongst young adults represents an important public health problem in the UK. Individuals’ attitude towards the use of condoms has been identified as an important determinant of behavioural intentions and action. The Theory of Planned Behaviour has been widely used to explain and predict health behaviour. This posits that the degree to which an individual positively or negatively values a behaviour (termed ‘direct attitude’) is based upon consideration of the likelihood of a number of outcomes occurring (outcome expectancy) weighted by the perceived desirability of those outcomes (outcome evaluation). Outcome expectancy and outcome evaluation when multiplied form ‘indirect attitude’. The study aimed to assess whether positive outcome expectancies of unprotected sex were more important for young adults with lower safe sex intentions, than those with safer sex intentions, and to isolate optimal outcomes for targeting through health promotion campaigns.MethodsA cross-sectional survey design was used. Data was collected from 1051 school and university students aged 16–24 years. Measures of intention, direct attitude and indirect attitude were taken. Participants were asked to select outcome expectancies which were most important in determining whether they would use condoms with casual sexual partners.ResultsPeople with lower safe sex intentions were more likely than those with safer sex intentions to select all positive outcome expectancies for unprotected sex as salient, and less likely to select all negative outcome expectancies as salient. Outcome expectancies for which the greatest proportion of participants in the less safe sex group held an unfavourable position were: showing that I am a caring person, making sexual experiences less enjoyable, and protecting against pregnancy.ConclusionsThe findings point to ways in which the attitudes of those with less safe sex intentions could be altered in order to motivate positive behavioural change. They suggest that it would be advantageous to highlight the potential for condom use to demonstrate a caring attitude, to challenge the potential for protected sex to reduce sexual pleasure, and to target young adults’ risk appraisals for pregnancy as a consequence of unprotected sex with casual sexual partners.

A survey of English teenagers' sexual experience and preferences for school-based sex education

Rates of sexually transmitted infections and teenage pregnancy amongst the under-16s are causing increasing concern. There is limited evidence about the sexual behaviour and sex education preferences of this age group, especially of those from Black and minority ethnic groups. This study aimed to provide data on early heterosexual risk behaviour, and to examine preferences for the content and delivery of sex and relationships education (SRE), across ethnicity, gender and school year to inform priority setting and sex education strategies. A cross-sectional study of 3334 13–17-year-olds from 10 English urban and suburban secondary schools was conducted. Multivariate analysis was performed to examine the independent effect of demographic variables on sexual experience and preferences for sex education. A number of important differences in the sexual experience and condom use of males and females across the ethnic groups were identified. Differences in preferences for the content and delivery of sex education were also identified, particularly between male and female pupils. The findings indicate the potential for quite wide variation in sexual experience and preferences within school classrooms. The challenge for educators is therefore to develop SRE curricula that are inclusive within the constraints of school teaching.

Stool submission by general practitioners in SW England - when, why and how? A qualitative study

BackgroundWe know little about when and why general practitioners (GPs) submit stool specimens in patients with diarrhoea. The recent UK-wide intestinal infectious disease (IID2) study found ten GP consultations for every case reported to national surveillance. We aimed to explore what factors influence GP’s decisions to send stool specimens for laboratory investigation, and what guidance, if any, informs them.MethodsWe used qualitative methods that enabled us to explore opinions and ask open questions through 20 telephone interviews with GPs with a range of stool submission rates in England, and a discussion group with 24 GPs. Interviews were transcribed and subjected to content analysis.ResultsInterviews: GPs only sent stool specimens to microbiology if diarrhoea persisted for over one week, after recent travel, or the patient was very unwell. Very few had a systematic approach to determine the clinical or public health need for a stool specimen. Only two GPs specifically asked patients about blood in their stool; only half asked about recent antibiotics, or potential food poisoning, and few asked about patients’ occupations. Few GPs gave patients advice on how to collect specimens.Results from interviews and discussion group in relation to guidance: All reported that the HPA stool guidance and patient collection instructions would be useful in their clinical work, but only one GP (an interviewee) had previously accessed them. The majority of GPs would value links to guidance on electronic requests. Most GPs were surprised that a negative stool report did not exclude all the common causes of IID.ConclusionsGPs value stool culture and laboratories should continue to provide it. Patient instructions on how to collect stool specimens should be within stool collection kits. Through readily accessible guidance and education, GPs need to be encouraged to develop a more systematic approach to eliciting and recording details in the patient’s history that indicate greater risk of severe infection or public health consequences. Mild or short duration IID (under one week) due to any cause is less likely to be picked up in national surveillance as GPs do not routinely submit specimens in these cases.

“What Should We Tell the Children About Relationships and Sex?”©: Development of a Program for Parents Using Intervention Mapping

This article describes the development of an intervention that aims to increase the quantity and quality of parent—child communication about sex and relationships. The intervention has been designed as part of a local strategic approach to teenage pregnancy and sexual health. The process and findings of Intervention Mapping (IM), a tool for the development of theory-and evidence-based interventions, are presented. The process involves a detailed assessment of the difficulties parents experience in communicating with their children about sex and relationships. The findings are translated into program and change objectives that specify what parents need to do to improve their communication. Theory-based practical strategies most likely to bring about the desired behavioral change are then identified and pretested. The intervention developed consists of a six-session facilitator-led program that targets parents’ attitudes, knowledge, communication skills, and self-efficacy. Following on from Bartholomew’s seminal work on IM, this article develops and extends the application of this process by presenting explicit detail on the behavioral change techniques used and their theoretical underpinnings. The strengths and weaknesses of IM as a process for the development of health behavior interventions are discussed.

Development of an intervention to increase sexual health service uptake by young people

This study aimed to develop and implement an intervention, delivered via a website and Web app, to increase the uptake of sexual health services by young people. The intervention was co-designed with a group of 10 young people. Intervention mapping was used to guide development. To identify barriers and facilitators of access to sexual health services, three focus groups with 24 young people aged 13 to 19 years, and interviews with 12 professionals recruited from across a range of health and social services, were conducted. Data were analyzed using content analysis. Evidence was supplemented through a literature review. Barriers and facilitators were categorized as theoretical determinants and then suitable behavior change techniques (BCTs) for targeting them were selected. Targeted determinants were attitude, subjective norm, perceived behavioral control, and knowledge. Selected BCTs included “information about others’ approval,” “framing/reframing,” and “credible source.” The website/app enable users to search for services, access key information about them, watch videos about what to expect, and have key concerns removed/addressed. This is the first known digital evidence-based intervention to target this behavior described in the literature. A clear and full description of intervention development and content, including of theorized causal pathways, is provided to aid interpretation of future outcome evaluations.

Identifying strategies to increase influenza vaccination in GP practices: a positive deviance approach

BACKGROUND Influenza (flu) is an acute viral infection of the respiratory tract, which can lead to serious complications for individuals within at-risk groups. Evidence indicates that aspects of organization and delivery within GP practices can have an influence on the rates of flu vaccination uptake. Positive deviance is a methodological approach that facilitates identification of factors associated with high performance. OBJECTIVE To use positive deviance to isolate factors associated with high performance by comparing GP practices achieving high and low flu vaccination uptake. METHODS This was a qualitative study. A total of 18 practice managers and 2 GPs from 20 GP practices participated, 10 with high and low vaccination rates, respectively. Telephone interviews were conducted, audio recorded and fully transcribed. Framework Analysis was used to analyse the data. RESULTS High uptake practices were more likely than low uptake practices to have a lead member of staff who demonstrated tenacity, have aspirational uptake targets, have developed and used additional prompts within their IT systems to identify eligible patients, have GPs who were opportunistically vaccinating and use phone calls as a first-line strategy to invite patients for vaccination. CONCLUSIONS This is the first known qualitative study to identify strategies used by UK GP practices to deliver seasonal flu vaccination programmes. It is one of few studies using the robust and novel approach of positive deviance to inform health care recommendations. This approach has offered new and more nuanced insights into GP practice factors associated high flu vaccination uptake beyond those captured through large-scale survey research.

Spring Fever: Process Evaluation of a Sex and Relationships Education Programme for Primary School Pupils.

Abstract In primary schools in England, programmes of Sex and Relationships Education (SRE) are rare. Provision has been judged as requiring improvement in over one-third of these schools at a time when statutory provision has been mandated by the government. The aim of this study was to examine the early implementation of Spring Fever, a programme of primary school SRE, in terms of reach, fidelity, dose, recruitment and context. Data were collected through a teachers’ feedback form (n = 10), teachers’ focus group (n = 9); a parent diary (n = 7), parents’ interviews (n = 5), parent feedback (n = 41) and pupil feedback (n = 24). Reach was high with few pupils withdrawn. Fidelity to the lesson plans and achievement of learning objectives was high for most school years. Pupils enjoyed the programme and responded well. It was clear that learning had occurred but that pupils had been uncomfortable with some topics. Teachers were largely positive about the programme. Parents felt that it was age-appropriate, informative and handled sensitively. This is the first process evaluation of primary school SRE. Detailed descriptions of process evaluation are uncommon in the literature but this is vital for identifying issues pertinent to the future roll-out and evaluation of programmes.

Attitude of patients with HIV infection towards organ transplant between HIV patients. A cross-sectional questionnaire survey

This study examined the HIV patients’ attitudes towards the practice of organ transplant between HIV patients using a cross-sectional survey design. In total, 206 patients participated with a mean age of 42 (±8.8) years. The majority (70%) were black African and women (54%), and 83% described themselves as heterosexual. Most participants (n = 171, 83%) were on treatment, and 159 (93%) had viral load less than 40 copies/ml. Mean duration of illness and mean duration of treatment were 77 (±42.7) and 68 (±41) months, respectively. Of all participants, 128 (62%) reported that they would consider donating either any organ or a specific organ/s to an HIV patient, 33 (16%) would not consider it and 45 (22%) were unsure about donating their organs. Furthermore, 113 (55%) participants would consider receiving an organ from an HIV patient, 37 (18%) would not consider it, and 56 (27%) were unsure. Ninety-eight participants (42%) reported that they would consider both donating and receiving an organ. Multinomial logistic regression analysis found that significantly more Black African than Caucasian participants were unsure about organ donation (p = 0.011, OR = 3.887). Participants with longer duration of infection were significantly less likely to consider receiving an organ from an HIV patient (p = 0.036, OR = 1.297). Overall, the study findings indicated that the majority of participants were in favour of organ transplant between HIV patients. Use of HIV-infected donors could potentially reduce current organ waiting list among HIV patients.

Beliefs underlying chlamydia risk appraisals: the relationship with young adults' intentions to use condoms

Risk appraisals are identified by many theories of health behaviour as primary motivators of intention and action. However, limited evidence is available on the beliefs underlying risk appraisals. The nature of these beliefs must be understood in order to optimally modify risk appraisals in ways that motivate positive behaviour change. This study uses Cameron’s illness risk representations framework to examine the extent to which beliefs about chlamydia predict risk appraisals and intentions to use condoms with casual sexual partners. A cross-sectional design was used. N = 921 secondary school and university students aged between 16 and 24 years completed the assessment of illness risk representations which includes measures of illness risk representation components namely identity, cause, timeline, consequences and control. As hypothesised, appraisals of the likelihood of chlamydia infection were positively associated with beliefs that symptoms of infection were present (identity), that exposure to chlamydia had occurred (cause) and that chlamydia affected young people (timeline). Severity appraisals were positively associated with beliefs that chlamydia would lead to pain, psychosocial and fertility consequences (all consequences scales). Contrary to hypotheses, severity appraisals were positively associated with beliefs that infection could be prevented (control over prevention) and cured (control over cure), and not associated with the belief that infection could be treated (control over treatment). Intentions to use condoms with casual sexual partners were predicted by beliefs about control over prevention. In conclusion, Cameron’s framework appears to be useful for examining the content of risk appraisals and isolating beliefs to be targeted through health promotion interventions. The findings have provided new evidence about the basis for young adults’ appraisals of the risk of chlamydia infection. They point to ways in which intentions to use condoms with casual sexual partners could be increased, through for example, developing skills around how to initiate condom use.