Myles Balfe

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.

What’s distressing about having type 1 diabetes? A qualitative study of young adults’ perspectives

BackgroundDiabetes distress is a general term that refers to the emotional burdens, anxieties, frustrations, stressors and worries that stem from managing a severe, complex condition like Type 1 diabetes. To date there has been limited research on diabetes-related distress in younger people with Type 1 diabetes. This qualitative study aimed to identify causes of diabetes distress in a sample of young adults with Type 1 diabetes.MethodsSemi-structured interviews with 35 individuals with Type 1 diabetes (23–30 years of age).ResultsThis study found diabetes related-distress to be common in a sample of young adults with Type 1 diabetes in the second phase of young adulthood (23–30 years of age). Diabetes distress was triggered by multiple factors, the most common of which were: self-consciousness/stigma, day-to-day diabetes management difficulties, having to fight the healthcare system, concerns about the future and apprehension about pregnancy. A number of factors appeared to moderate distress in this group, including having opportunities to talk to healthcare professionals, attending diabetes education programmes and joining peer support groups. Young adults felt that having opportunities to talk to healthcare professionals about diabetes distress should be a component of standard diabetes care.ConclusionsSome aspects of living with diabetes frequently distress young adults with Type 1 diabetes who are in their twenties. Clinicians should facilitate young adults’ attendance at diabetes education programmes, provide them with opportunities to talk about their diabetes-related frustrations and difficulties and, where possible, assist in the development of peer-support networks for young adults with diabetes.

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.

Where do young Irish women want Chlamydia-screening services to be set up? A qualitative study employing Goffman's impression management framework

We conducted interviews with 35 young women recruited from eight community healthcare rural and urban settings across two regions of Ireland. The aim of the study was to explore where these women thought Chlamydia-screening services should be located. Respondents wanted screening services to be located in settings where they would not be witnessed either asking for, or being asked to take, Chlamydia tests. Respondents were worried that their identities would become stigmatized if others were to find out that they had accepted screening. Findings are interpreted through Goffmans stigma and impression management framework. We conclude with public health recommendations.

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.

Using Facebook to recruit young adults for qualitative research projects: how difficult is it?

DOI: 10.1097/NXN.0b013e31826e4fca Recruiting participants is a challenge for any research study. Traditionally, researchers have gone to significant lengths to recruit samples, including mailing letters, putting recruitment information in the media, and canvassing locations where potential participants might be found. More recently, researchers have begun to use the Internet to recruit research samples. In theory, the Internet has a number of strengths when used for this purpose. It should enable a large number of individuals to be contacted in a cost-effective manner in a short period. It should also help researchers to capture hard-to-reach populations. The Internet is considered to be a particularly suitable medium for recruiting younger people. Recently, social networks have become important features on the Internet landscape. These are Web-based services that allow individuals to develop online profiles and connect with people who are similar to them. More than half of young adults are on social network sites, most of whom use these sites every day. At the time of writing this article, Facebook (Facebook, Menlo Park, CA) is the dominant social network site on the Internet, with close to a billion members. A feature of Facebook is that its users can join together to form “user groups” based around shared interests. These groups can be located by searching Facebook. Because of its reach and the prevalence of health-related user groups on the site, Facebook is considered to be a promising new way to recruit young adults into medical research. Key Points •Researchers are increasingly using social network sites such as Facebook to recruit patients for research studies. •Qualitative researchers may experience a lower and slower than expected response to Facebook recruitment campaigns. •We suggest that researchers continue to recruit from traditional settings in tandem with Facebook.

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.

Dealing with the devil: weight loss concerns in young adult women with type 1 diabetes

AIMS AND OBJECTIVES To examine the weight loss concerns of young adults with type 1 diabetes. BACKGROUND Eating disorders are prevalent in young women with type 1 diabetes. DESIGN Qualitative. METHODS Interviews with 35 young adults (23-30 years of age) with type 1 diabetes and 13 healthcare professionals. RESULTS Most female interviewees were concerned about the difficulties of losing weight when having diabetes. Six female interviewees developed severe eating disturbances when they were younger. These women initially regarded their disturbed eating behaviour positively and engaged in weight loss activities intermittently. However, over time, they lost control of their behaviour, and it came to dominate their lives. Family conflict often intensified disordered eating behaviours. Eventually all of these women managed to transition away from their behaviour, although this process took, for some of them, several years. Several of them (now in their early to late twenties), however, continued to struggle with weight loss impulses. Healthcare professionals felt that eating- and weight-related issues often went undiagnosed and undocumented in young adult women with type 1 diabetes. CONCLUSION Many young women with type 1 diabetes are worried about their weight, but will not engage in risky weight loss activities because of concerns about their health. A minority of young adult women will develop more severe eating-related disturbances. These eating disturbances may last a significant amount of time before clinicians become aware of them. These women may also experience disordered weight loss impulses for sometime after clinical interventions. RELEVANCE TO CLINICAL PRACTICE Clinicians should screen young adult women with type 1 diabetes for eating disorders and monitor young adult women who have developed eating disorders over the longer term. There may be a need to provide asymptomatic young women with diabetes with information about the potential risks of insulin omission.

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.

Why Did U.S. Healthcare Professionals Become Involved in Torture During the War on Terror

This article examines why U.S. healthcare professionals became involved in “enhanced interrogation,” or torture, during the War on Terror. A number of factors are identified including a desire on the part of these professionals to defend their country and fellow citizens from future attack; having their activities approved and authorized by legitimate command structures; financial incentives; and wanting to prevent serious harm from occurring to prisoners/detainees. The factors outlined here suggest that psychosocial factors can influence health professionals’ ethical decision-making.