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Nearchou F, Flinn C, Mc Laughlin D, Niland R. Sexual health behaviours and partner notification practices related to sexually transmitted infections in young adults in Ireland. Ir J Med Sci 2024:10.1007/s11845-024-03668-8. [PMID: 38517599 DOI: 10.1007/s11845-024-03668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) impose burdens on individuals and communities, while their prevalence in young people has risen continually in recent years. Partner notification is an effective public health strategy which can limit STI transmission. AIMS This study aimed to explore young adults' sexual health behaviours, attitudes toward STI testing, and feelings toward visiting a sexual health clinic. It also aimed to investigate preferences for partner notification and the role of self-efficacy in people's intentions to notify a partner for STIs including the human immunodeficiency virus (HIV). METHODS A quantitative, cross-sectional design was applied. Participants were 400 adults aged 18-34 years (M = 23 years; SD = 4.27), recruited from the Republic of Ireland. RESULTS Over half of the participants reported never being tested for STIs. These young people placed less importance on undergoing regular STI testing and testing after unprotected sex than their counterparts who had been tested for STIs. Self-efficacy was significantly associated with intentions to notify partner(s) for STIs including HIV. CONCLUSIONS As STIs are becoming increasingly prevalent in young adults, it is important to gain a deeper understanding of the interventions used to break the transmission chain and how different beliefs and attitudes may affect them. Self-efficacy was a key component in PN intentions, suggesting that the belief in someone's ability or skillset to perform a sexual health behaviour is positively related to their intention to perform the behaviour.
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Affiliation(s)
- Finiki Nearchou
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland.
| | - Clodagh Flinn
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
| | - Diarmuid Mc Laughlin
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
| | - Rachel Niland
- School of Psychology, Newman Building, University College Dublin, Belfield Campus, Dublin 4, Dublin, Ireland
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Bittleston H, Hocking JS, Temple-Smith M, Sanci L, Goller JL, Coombe J. What sexual and reproductive health issues do young people want to discuss with a doctor, and why haven't they done so? Findings from an online survey. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100966. [PMID: 38522395 DOI: 10.1016/j.srhc.2024.100966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Young people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues. METHODS We conducted an online survey (2nd May - 21st June 2022) of Australians aged 16-29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with 'undiscussed SRH issues') were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis. RESULTS A total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs. CONCLUSIONS Many young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.
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Affiliation(s)
- H Bittleston
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia.
| | - J S Hocking
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - M Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - L Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - J L Goller
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - J Coombe
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
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3
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Tambling RR, Reckert A. Barriers to help seeking and provider preferences for sexual functioning concerns among undergraduates. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:633-643. [PMID: 31944927 DOI: 10.1080/07448481.2019.1705835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/03/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
Researchers who have studied help-seeking for sexual health concerns have consistently documented that individuals, couples, and families underutilize sexual health services. Additionally, research has demonstrated that individuals endorse myriad barriers to seeking informal and formal help, especially for sexual health concerns. This study examined past, present, and future provider preferences for sexual functioning concerns. Participants: A sample of 347 undergraduate students at a large university in the Northeast United States. Methods: Participants responded to questionnaires about their help-seeking behaviors for formal and informal help sources. Results: Despite the occurrence of sexual functioning concerns in the current study, services that address sexual concerns were largely underutilized. However, barriers to seeking help and negative attitudes toward seeking help did not seem to be primary reasons for the underutilization of services for the current sample. Results also indicated that providers that focus specifically on the treatment of sexual functioning concerns are among the most underutilized services. Discussion: Implications for sexual health providers based on results are provided.
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Affiliation(s)
- Rachel R Tambling
- Department of Human Development and Family Science, University of Connecticut, Storrs, Connecticut, USA
| | - Ashley Reckert
- Department of Human Development and Family Science, University of Connecticut, Storrs, Connecticut, USA
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Mapp F, Wellings K, Mercer CH, Mitchell K, Tanton C, Clifton S, Datta J, Field N, Palmer MJ, Hickson F. Help-seeking for genitourinary symptoms: a mixed methods study from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Open 2019; 9:e030612. [PMID: 31666264 PMCID: PMC6830646 DOI: 10.1136/bmjopen-2019-030612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Quantify non-attendance at sexual health clinics and explore help-seeking strategies for genitourinary symptoms. DESIGN Sequential mixed methods using survey data and semistructured interviews. SETTING General population in Britain. PARTICIPANTS 1403 participants (1182 women) from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; undertaken 2010-2012), aged 16-44 years who experienced specific genitourinary symptoms (past 4 weeks), of whom 27 (16 women) who reported they had never attended a sexual health clinic also participated in semistructured interviews, conducted May 2014-March 2015. PRIMARY AND SECONDARY OUTCOME MEASURES From survey data, non-attendance at sexual health clinic (past year) and preferred service for STI care; semistructured interview domains were STI social representations, symptom experiences, help-seeking responses and STI stigma. RESULTS Most women (85.9% (95% CI 83.7 to 87.9)) and men (87.6% (95% CI 82.3 to 91.5)) who reported genitourinary symptoms in Natsal-3 had not attended a sexual health clinic in the past year. Around half of these participants cited general practice (GP) as their preferred hypothetical service for STI care (women: 58.5% (95% CI 55.2% to 61.6%); men: 54.3% (95% CI 47.1% to 61.3%)). Semistructured interviews elucidated four main responses to symptoms: not seeking healthcare, seeking information to self-diagnose and self-treat, seeking care at non-specialist services and seeking care at sexual health clinics. Collectively, responses suggested individuals sought to gain control over their symptoms, and they prioritised emotional reassurance over accessing medical expertise. Integrating survey and interview data strengthened the evidence that participants preferred their general practitioner for STI care and extended understanding of help-seeking strategies. CONCLUSIONS Help-seeking is important to access appropriate healthcare for genitourinary symptoms. Most participants did not attend a sexual health clinic but sought help from other sources. This study supports current service provision options in Britain, facilitating individual autonomy about where to seek help.
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Affiliation(s)
- Fiona Mapp
- Institute for Global Health, University College London, London, UK
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kirstin Mitchell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Clare Tanton
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
| | - Jessica Datta
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Melissa J Palmer
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ford Hickson
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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5
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Mapp F, Wellings K, Hickson F, Mercer CH. Understanding sexual healthcare seeking behaviour: why a broader research perspective is needed. BMC Health Serv Res 2017; 17:462. [PMID: 28683744 PMCID: PMC5501268 DOI: 10.1186/s12913-017-2420-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 06/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite effective and accessible treatments, many sexually transmitted infections (STIs) in high-income countries go untreated, causing poor sexual health for individuals and their partners. Research into STI care has tended to focus on biomedical aspects of infections using patient samples and prioritised attendance at healthcare services. This approach overlooks the broader social context of STIs and healthcare-seeking behaviours, which are important to better understand the issue of untreated infections. MAIN BODY This paper is structured around three main arguments to improve understanding of help-seeking behaviour for STIs in order to help reduce the burden of untreated STIs for both individuals and public health. Firstly, biomedical perspectives must be combined with sociological approaches to align individual priorities with clinical insights. More research attention on understanding the subjective experiences of STI symptoms and links to healthcare-seeking behaviour is also needed. Secondly, a focus on non-attendance at healthcare services is required to address the patient-centric focus of STI research and to understand the reasons why individuals do not seek care. Finally, research using non-patient samples recruited from outside medical contexts is vital to accurately reflect the range of behaviours, beliefs and health issues within the population to ensure appropriate and effective service provision. We suggest piggy-backing other research on to existing studies as an effective way to recruit participants not defined by their patient status, and use a study recruiting a purposive non-patient sample from an existing dataset - Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) as an illustrative example. CONCLUSION STIs are common but treatable, however a range of social and cultural factors prevent access to healthcare services and contribute to the burden of untreated infection. Different conceptual and empirical approaches are needed to better understand care-seeking behaviour and reduce the gap between social and biomedical advancements in managing untreated infection.
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Affiliation(s)
- Fiona Mapp
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Ford Hickson
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Catherine H. Mercer
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, WC1E 6JB UK
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Howarth AR, Day S, Greene L, Ward H. "They made me feel comfortable": a comparison of methods to measure patient experience in a sexual health clinic. BMC Health Serv Res 2017; 17:325. [PMID: 28476173 PMCID: PMC5418717 DOI: 10.1186/s12913-017-2264-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/25/2017] [Indexed: 11/17/2022] Open
Abstract
Background High quality sexual health services are needed to improve both individual and public health outcomes. This study set out to explore what is important to patients who visit a sexual health clinic, and examine their understanding of standard survey questions, in order to inform the collection and interpretation of patient experience data that are used to improve services. Methods We conducted a cross-sectional, qualitative study. In the first part of the interview, we used “discovery interviews” to explore patients’ experiences of attending a central London walk-in sexual health clinic. In the second part, we asked patients how they would respond to eight standard patient experience survey questions and to provide an explanation for each of their responses. We conducted a thematic analysis of the interview data. Results We interviewed seventeen participants (nine women, eight men) of different ethnicities and backgrounds. All interviewees were positive about their experience. They described how staff had made them feel “comfortable”, and talked about how staff spent time, listened and did not rush them, despite being a very busy clinic. In response to the survey questions, fourteen patients rated their as care excellent or very good overall. However, survey questions were interpreted in different ways and were not always easily understood. Conclusions The open-ended “discovery interviews” provided new insights into aspects of care that were most valued or could improve. Standard patient experience questions provide a rating but little elucidation of the experiences that lie behind patients’ responses. They do not always measure aspects of care valued by patients or identify areas for improvement. They are not uniformly understood and necessarily collapse a wide range of experiences and views into categories that may seem inappropriate. Qualitative methods have a key role in measuring patient experience and involving patients in service improvement.
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Affiliation(s)
- Alison R Howarth
- Patient Experience Research Centre, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Sophie Day
- Patient Experience Research Centre, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Linda Greene
- Jefferiss Wing Centre for Sexual Health, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
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McCarthy C. Intrauterine contraception insertion pain: nursing interventions to improve patient experience. J Clin Nurs 2017; 27:9-21. [PMID: 28177530 DOI: 10.1111/jocn.13751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2017] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To examine factors which contribute to the individual's experience of pain in relation to intrauterine contraception insertion and determine evidence-based nursing strategies to best assess and manage this pain. BACKGROUND Nurses are increasingly involved in consultations regarding intrauterine contraception. However, concerns regarding painful or difficult insertion may inhibit uptake and discourage nurses from promoting or inserting intrauterine contraception. DESIGN Integrative review. METHODS Database searches of CINAHL, PubMed, Wiley Online Library and the Cochrane Collaboration for relevant literature. Eight papers met the inclusion criteria and were analysed using an integrative review process. RESULTS Physical causes and pharmacological interventions for insertion pain have been thoroughly investigated. Absence of previous vaginal delivery and anxiety may increase the likelihood of procedural pain. The literature fails to conclusively determine any universally effective prophylactic analgesia. Cervical anaesthesia may be beneficial in some cases and oral analgesia may relieve postprocedural pain. Distraction in the form of conversation, music or television can be effective in reducing anxiety. CONCLUSIONS A combination of physical, psychological and environmental factors contribute to the individual's pain experience. Nurses have the potential to make a significant impact on pain outcomes by demonstrating clinical expertise and creating a trustful environment. Giving reliable information, acknowledging the significance of anxiety and providing reassurance and distraction are effective pain reducing strategies. Research into nonpharmacological approaches is warranted, especially those which reduce anxiety. RELEVANCE TO CLINICAL PRACTICE Increasing uptake of long-acting reversible contraception is a public health goal. Providing effective pain management strategies to improve patient experience may encourage more nurses to recommend, or enhance their scope of practice to include, intrauterine contraception insertion.
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Affiliation(s)
- Carmel McCarthy
- Cripps Health Centre, University of Nottingham Health Service, Nottingham, UK
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8
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Aicken CRH, Fuller SS, Sutcliffe LJ, Estcourt CS, Gkatzidou V, Oakeshott P, Hone K, Sadiq ST, Sonnenberg P, Shahmanesh M. Young people's perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study. BMC Public Health 2016; 16:974. [PMID: 27624633 PMCID: PMC5022229 DOI: 10.1186/s12889-016-3648-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 09/07/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Control of sexually transmitted infections (STI) is a global public health priority. Despite the UK's free, confidential sexual health clinical services, those at greatest risk of STIs, including young people, report barriers to use. These include: embarrassment regarding face-to-face consultations; the time-commitment needed to attend clinic; privacy concerns (e.g. being seen attending clinic); and issues related to confidentiality. A smartphone-enabled STI self-testing device, linked with online clinical care pathways for treatment, partner notification, and disease surveillance, is being developed by the eSTI(2) consortium. It is intended to benefit public health, and could do so by increasing testing among populations which underutilise existing services and/or by enabling rapid provision of effective treatment. We explored its acceptability among potential users. METHODS In-depth interviews were conducted in 2012 with 25 sexually-experienced 16-24 year olds, recruited from Further Education colleges in an urban, high STI prevalence area. Thematic analysis was undertaken. RESULTS Nine females and 16 males participated. 21 self-defined as Black; three, mixed ethnicity; and one, Muslim/Asian. 22 reported experience of STI testing, two reported previous STI diagnoses, and all had owned smartphones. Participants expressed enthusiasm about the proposed service, and suggested that they and their peers would use it and test more often if it were available. Utilizing sexual healthcare was perceived to be easier and faster with STI self-testing and online clinical care, which facilitated concealment of STI testing from peers/family, and avoided embarrassing face-to-face consultations. Despite these perceived advantages to privacy, new privacy concerns arose regarding communications technology: principally the risk inherent in having evidence of STI testing or diagnosis visible or retrievable on their phone. Some concerns arose regarding the proposed self-test's accuracy, related to self-operation and the technology's novelty. Several expressed anxiety around the possibility of being diagnosed and treated without any contact with healthcare professionals. CONCLUSIONS Remote STI self-testing and online care appealed to these young people. It addressed barriers they associated with conventional STI services, thus may benefit public health through earlier detection and treatment. Our findings underpin development of online care pathways, as part of ongoing research to create this complex e-health intervention.
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Affiliation(s)
- Catherine R. H. Aicken
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Sebastian S. Fuller
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lorna J. Sutcliffe
- Blizard Institute, Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claudia S. Estcourt
- Blizard Institute, Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - S. Tariq Sadiq
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Maryam Shahmanesh
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
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Mason L. Knowledge of sexually transmitted infections and sources of information amongst men. ACTA ACUST UNITED AC 2016; 125:266-71. [PMID: 16353457 DOI: 10.1177/146642400512500608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate menís awareness of sexually transmitted infections (STIs) and sexual health services, together with the best ways of providing information about them. Information was collated via a self-administered questionnaire, which was answered by 429 men, giving a response rate of 31%. Men aged 16+ living in two primary care trusts (PCTs) in the north-west of England were accessed through a range of different sources, including social, educational, health, work and religious facilities. Despite the high rates of STIs in the north-west, approximately one in five men had not heard of herpes, syphilis or chlamydia. One in ten had not heard of gonorrhoea. The majority of men were unaware that many STIs could be asymptomatic. Only 13% knew where their local genitourinary medicine (GUM) clinic was. The main deterrents to accessing the clinic were embarrassment and not knowing where it was. Menís knowledge of STIs is limited, particularly in relation to the symptoms. The best way of providing information, according to the respondents, was through their general practitioner (GP). However, in practice this might be difficult, as men are reluctant users of GP services in general. Knowledge of the whereabouts of the local GUM clinics is also limited. Although most men thought that they would visit their GP if they thought they might have an STI, this may result from them not knowing the alternatives, rather than having a real choice. More information, targeted wisely, is thus necessary in order to educate men about STIs and service provision.
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Affiliation(s)
- Linda Mason
- Centre for Research in Healthcare, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, England.
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10
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Whiddett D, Hunter I, McDonald B, Norris T, Waldon J. Consent and widespread access to personal health information for the delivery of care: a large scale telephone survey of consumers' attitudes using vignettes in New Zealand. BMJ Open 2016; 6:e011640. [PMID: 27554103 PMCID: PMC5013334 DOI: 10.1136/bmjopen-2016-011640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In light of recent health policy, to examine factors which influence the public's willingness to consent to share their health information in a national electronic health record (EHR). DESIGN Data were collected in a national telephone survey in 2008. Respondents were presented with vignettes that described situations in which their health information was shared and asked if they would consent to such sharing. The subset, consisting of the 18 vignettes that covered proving care, was reanalysed in depth using new statistical methods in 2016. SETTING Adult population of New Zealand accessible by telephone landline. PARTICIPANTS 4209 adults aged 18+ years in the full data set, 2438 of which are included in the selected subset. MAIN OUTCOME MEASURES For each of 18 vignettes, we measured the percentage of respondents who would consent for their information to be shared for 2 groups; for those who did not consider that their records contained sensitive information, and for those who did or refused to say. RESULTS Rates of consent ranged from 89% (95% CI 87% to 92%) for sharing of information with hospital doctors and nurses to 51% (47% to 55%) for government agencies. Mixed-effects logistic regression was used to identify factors which had significant impact on consent. The role of the recipient and the level of detail influenced respondents' willingness to consent (p<0.0001 for both factors). Of the individual characteristics, the biggest impact was that respondents whose records contain sensitive information (or who refused to answer) were less willing to consent (p<0.0001). CONCLUSIONS A proportion of the population are reluctant to share their health information beyond doctors, nurses and paramedics, particularly when records contain sensitive information. These findings may have adverse implications for healthcare strategies based on widespread sharing of information. Further research is needed to understand and overcome peoples' ambivalence towards sharing their information.
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Affiliation(s)
- Dick Whiddett
- School of Management, College of Business, Massey University, Palmerston North, New Zealand
| | - Inga Hunter
- School of Management, College of Business, Massey University, Palmerston North, New Zealand
| | - Barry McDonald
- Institute of Natural and Mathematical Sciences, Massey University, Auckland, New Zealand
| | - Tony Norris
- School of Engineering and Advanced Technology, Massey University, Auckland, New Zealand
| | - John Waldon
- Faculty of Medicine, Muru Marri Indigenous Health Unit, School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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11
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Mapp F, Hickson F, Mercer CH, Wellings K. How social representations of sexually transmitted infections influence experiences of genito-urinary symptoms and care-seeking in Britain: mixed methods study protocol. BMC Public Health 2016; 16:548. [PMID: 27400780 PMCID: PMC4940703 DOI: 10.1186/s12889-016-3261-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social understandings of sexually transmitted infections and associated symptoms and care-seeking behaviour continue to lag behind advancements in biomedical diagnostics and treatment, perpetuating the burden of disease. There is a lack of research linking perceptions, experiences and care-seeking for sexual health issues, especially research conducted outside of medical settings. We aim to explore lay perceptions of STIs and how these influence experiences of genito-urinary symptoms and associated care-seeking behaviour, in women and men in Britain. METHODS AND DESIGN This study adopts a participant-selection variant of the explanatory sequential mixed methods design to incorporate quantitative and qualitative strands. We use data from Britain's third National Survey of Sexual Attitudes and Lifestyles (n = 15,162) to analyse national patterns of symptom experience and care-seeking, and to identify a purposive qualitative sample. Semi-structured interviews (n = 27) following up with survey participants include a novel flash card activity providing qualitative data about infection perceptions, symptom experiences and decisions about healthcare. Quantitative and qualitative data are analysed separately using complex survey analyses and principles of Interpretative Phenomenological Analysis respectively. Data are then integrated in a subsequent phase of analysis using matrices to compare, contrast and identify silences from each method. DISCUSSION This is an ongoing mixed methods study collecting, analysing and synthesising linked data from a national survey and follow-up semi-structured interviews. It adds explanatory potential to existing national survey data and is likely to inform future surveys about sexual health. Given the current uncertainty around service provision in Britain, this study provides timely data about symptom experiences and care-seeking behaviour which may inform future commissioning of sexual healthcare.
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Affiliation(s)
- Fiona Mapp
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ford Hickson
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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12
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McManus IC, Stubbings GF, Martin N. Stigmatization, Physical Illness and Mental Health in Primary Ciliary Dyskinesia. J Health Psychol 2016; 11:467-82. [PMID: 16774899 DOI: 10.1177/1359105306063320] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) causes chronic cough, sinusitis and bronchiectasis, and half of patients also show situs inversus. The genetic basis and visible and concealed chronic symptoms provide potential for stigmatization. We describe a structural equation model linking a questionnaire measure of stigmatization to sex, age, personality (Big Five), symptoms (St George’s Respiratory Questionnaire), health status (SF-36) and stress (GHQ-12). Stigma did not relate to physical symptoms or health, or to situs, but correlated with mental health and the social impact of symptoms. Neuroticism, extroversion, openness to experience, age, age at diagnosis and being female indirectly affected stigmatization via mental health.
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Mulholland E, Van Wersch A. Stigma, Sexually Transmitted Infections and Attendance at the GUM Clinic. J Health Psychol 2016; 12:17-31. [PMID: 17158837 DOI: 10.1177/1359105306069098] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A gap in the literature regarding understanding of people's health care seeking behaviours in relation to sexually transmitted infections is identified. Employing both deductive and inductive methods, 10 patients (five female, five male) were interviewed to explore the psychosocial, motivational and attitudinal factors associated with attendance at a Genito-Urinary Medicine (GUM) clinic in a close-knit community in the north of England. Seven stigma-related themes were identified as salient issues surrounding perceptions of sexual health screening and included: (1)prejudice surrounding STIs; (2)fear of exposure; (3)isolation; (4)reluctance to attend; (5)contamination; (6)relationship issues; and (7)perceived invulnerability. Within these themes distinct gender differences were identified. Implications for the theory of planned behaviour (TPB) are discussed against the factors identified.
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Jackson LJ, Roberts TE. Conceptualising quality of life outcomes for women participating in testing for sexually transmitted infections: A systematic review and meta-synthesis of qualitative research. Soc Sci Med 2015; 143:162-70. [PMID: 26360418 DOI: 10.1016/j.socscimed.2015.08.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 07/17/2015] [Accepted: 08/27/2015] [Indexed: 11/30/2022]
Abstract
Many public health interventions have aims which are broader than health alone; this means that there are difficulties in using outcome measures that capture health effects only, such as Quality Adjusted Life Years (QALYs). Sexually Transmitted Infections (STIs) are a major public health concern both in the UK and globally, with Chlamydia trachomatis being the most common bacterial STI worldwide. There is scope for the wider use of qualitative syntheses in health-related research; in this study we highlight their potential value in informing outcome identification, particularly for public health interventions where a broad range of outcomes may need to be considered. This article presents a systematic review and meta-ethnography of qualitative studies that investigated women's experiences of thinking about and participating in testing for chlamydia. The meta-ethnography highlights issues relating to beliefs about STIs and testing, assessing risk and interpreting symptoms, emotional responses to testing, coping with diagnosis, relationship with sex partners(s), informal support, and interaction with health care services. The study findings suggest that women can experience a range of impacts on their health and quality of life. It is important that this range of effects is taken into account within evaluations, to ensure that decision makers are fully informed about the outcomes associated with screening interventions, and ultimately, to make sure that appropriate interventions are available to support women in maintaining good sexual health.
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Affiliation(s)
- Louise J Jackson
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK.
| | - Tracy E Roberts
- Health Economics Unit, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
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15
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Williams JR, Gavin LE, Carter MW, Glass E. Client and Provider Perspectives on Quality of Care: A Systematic Review. Am J Prev Med 2015; 49:S93-S106. [PMID: 26190852 PMCID: PMC10506178 DOI: 10.1016/j.amepre.2015.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 11/18/2022]
Abstract
CONTEXT A central premise of the literature on healthcare quality is that improving the quality of care will lead to improvements in health outcomes. A systematic review was conducted to better inform quality improvement efforts in the area of family planning. The objective of this systematic review is to update a previous review focused on the quality of family planning services, namely, the impact of quality improvement efforts and client perspectives about what constitutes quality family planning services. In addition, this review includes new literature examining provider perspectives. EVIDENCE ACQUISITION Multiple databases from January 1985 through January 2015 were searched within the peer-reviewed literature that described the quality of family planning services. The retrieval and inclusion criteria included full-length articles published in English, which described studies occurring in a clinic-based setting to include family planning services. EVIDENCE SYNTHESIS Search strategies identified 16,145 articles, 16 of which met the inclusion criteria. No new intervention studies addressing the impact of quality improvement efforts on family planning outcomes were identified. Sixteen articles provided information relevant to client or provider perspectives about what constitutes quality family planning services. Clients and providers mostly identified the need for services that were accessible, client-centered, and equitable. Themes related to effectiveness, efficiency, and safety were mentioned less frequently. CONCLUSIONS Family planning services that account for both patient and provider perspectives may be more effective. Further research is needed to examine the impact of improved quality on provider practices, client behavior, and health outcomes.
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Affiliation(s)
- Jessica R Williams
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida; MANILA Consulting Group, Inc., McLean, Virginia.
| | - Loretta E Gavin
- Division of Reproductive Health, CDC, Atlanta, Georgia; Office of Population Affairs, USDHHS, Washington, District of Columbia
| | | | - Evelyn Glass
- Office of Population Affairs, USDHHS, Washington, District of Columbia
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16
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Kerry SR, Nightingale CM, Hay P, Oakeshott P. Which sexually active female students get themselves tested for Chlamydia trachomatis? A cohort study. Int J STD AIDS 2015; 27:586-90. [PMID: 25999170 DOI: 10.1177/0956462415587636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
Using data from the Prevention of Pelvic Infection (POPI) chlamydia screening trial, we compared the characteristics of female students who did or did not get tested for chlamydia outside the trial during 12 months' follow-up. Of the 2529 women in the trial, we excluded 68 chlamydia positives in the intervention group who were referred for treatment at baseline. Of the remaining 2461 women, 1980 (80%) answered the question about testing during follow-up on their 12 months' questionnaire and were included in the cohort. Of 1980 respondents, 529 (27%) reported having an independent chlamydia test, including 30 (48%) of 63 women with undiagnosed chlamydia at baseline. Predictors of testing included having undiagnosed chlamydia at baseline (adjusted odds ratio 2.44; 95% confidence interval 1.39-4.28), ≥2 sexual partners in the year prior to baseline (OR 1.99; 95% CI 1.60-2.48), history of sexually transmitted infection (1.63: 1.20-2.22); symptoms of pelvic discomfort, dyspareunia, abnormal vaginal discharge or inter-menstrual bleeding (1.38; 1.09-1.73); and black ethnicity (1.37, 1.06-1.76). Although more women with risk factors got tested, half of women with undiagnosed chlamydia did not get tested. To optimise detection of chlamydia, testing should be offered routinely.
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Affiliation(s)
- Sarah R Kerry
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, UK
| | - Phillip Hay
- Department of Genitourinary Medicine, St George's Hospital, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London, UK
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17
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Bell K, McCaffery KJ, Irwig L. Screening tests for gonorrhoea should first do no harm. Med J Aust 2015; 202:281-2. [DOI: 10.5694/mja15.00067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/09/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Katy Bell
- Bond University, Gold Coast, QLD
- University of Sydney, Sydney, NSW
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18
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Normansell R, Drennan VM, Oakeshott P. Exploring access and attitudes to regular sexually transmitted infection screening: the views of young, multi-ethnic, inner-city, female students. Health Expect 2015; 19:322-30. [PMID: 25703741 DOI: 10.1111/hex.12354] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Low uptake of sexually transmitted infection (STI) testing by young people is a major public health problem worldwide. The aims of this qualitative, community-based study were to explore access and attitudes to STI screening in high risk, young, ethnically diverse female students. METHODS Qualitative semi-structured interviews were conducted at an inner-London further education college with 17 women aged 16-25 years. RESULTS The women wanted convenient, regular STI testing and perceived this as responsible behaviour. However, they doubted the maturity of their peers who were unlikely to view themselves as candidates for testing, and feared the perceived stigma associated with testing. This was reflected in their preference for confidential testing. Despite attending their general practice for non-sexual health matters, most did not consider this option for STI testing. However, the long wait in specialist clinics was an important barrier. Many younger participants would not want postal STI sample kits sent to their homes. We found dissatisfaction with sexual health education. CONCLUSIONS STI screening for underserved groups such as young sexually active ethnically diverse female college students needs to be confidential, convenient, easily accessed and offered in ways that allow them to consider themselves as candidates for such screening without fear of social stigma. Family doctors should be aware that young women often do not perceive primary care to be an option for accessing STI screening, and could consider ways of advertising these services. Policymakers and commissioners should be aware that clinic waiting times and lack of education remain barriers to testing.
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Affiliation(s)
- Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Vari M Drennan
- Faculty of Health, Social Care & Education, St. George's, University of London & Kingston University, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK
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Thomson A, Morgan S, Henderson K, Tapley A, Spike N, Scott J, van Driel M, Magin P. Testing and screening for chlamydia in general practice: a cross-sectional analysis. Aust N Z J Public Health 2014; 38:542-7. [PMID: 25308467 DOI: 10.1111/1753-6405.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/01/2014] [Accepted: 05/01/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening. METHODS A cross-sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars' consultations. Registrars record details of 60 consecutive consultations in each GP-term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor-initiated screening. RESULTS Testing occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15-25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor-initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctor-initiated. CONCLUSIONS GP registrars screen for chlamydia disproportionately in younger females and new patients. IMPLICATIONS Our findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services.
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Affiliation(s)
- Allison Thomson
- Discipline of General Practice, Faculty of Health and Medicine, University of Newcastle, New South Wales
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20
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Hengel B, Jamil MS, Mein JK, Maher L, Kaldor JM, Guy RJ. Outreach for chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13:1040. [PMID: 24188541 PMCID: PMC3819260 DOI: 10.1186/1471-2458-13-1040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022] Open
Abstract
Background High Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence have been reported in populations that do not regularly access health centres for sexually transmissible infections (STI) testing. We reviewed current outreach strategies used to increase access to STI testing and their outcomes. Methods We systematically reviewed the literature for English language studies published between 1 January 2005 and 28 January 2011 describing CT and/or NG screening programs in non-clinical outreach settings. Results We identified 25 programs, with the majority occurring in either Australia (32%) or the United States (32%). The most common target groups were young people aged 15–29 years (52%), men who have sex with men (24%) and sex workers (8%). The median CT positivity was 7.7% (Inter Quartile Range [IQR]: 3.0%-11.1%, n=19 programs), and median NG positivity was 2.6% (IQR: 0.0%-8.0%, n=10). The median participation rate was 53% (IQR: 23.9%-81.3%), and a median of 79.6% (IQR: 55.1%-89.4%) of participants were tested, with a median of 100 tests conducted per program (IQR: 65–331, range: 11–1808). Across all settings the participation rate was highest among target groups gathering in community service venues (community centres, parenting centres, homeless shelters) (median=81.4%, n=4), and social venues (sporting venues or bars) (80.4%, n=1). Lower participation rates were found in street/public community areas (median=23.9%, n=3) and sex on premises venues (10.4% and 24.3%, n=2). Conclusions The review indicated that although CT and NG outreach programs reached a relatively small number of people the yield of infections is high. Settings which appear to be more effective at encouraging participation appear to be those within an existing venue, rather than in public areas.
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21
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Sauer U, Singh A, Rubenstein P, Pittrof R. Do women requesting only contraception find attendance at an integrated sexual health clinic more stigmatizing than attendance at a family planning-only clinic? Int J Womens Health 2013; 5:57-64. [PMID: 23439881 PMCID: PMC3576888 DOI: 10.2147/ijwh.s39895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose Both sexually transmitted infections and the genitourinary medicine clinics that patients attend for management of sexually transmitted infections are stigmatized by patients’ perceptions. The aim of this study was to assess whether women requesting contraception only find attendance at an integrated sexual health clinic (ISHC) more stigmatizing than attendance at a family planning (FP)–only clinic. Patients and methods Women requesting contraception only were asked to complete a stigma assessment questionnaire in the waiting room of the clinic they attended. Ease of understanding was assessed for each item of the questionnaire prior to commencement of the survey. The questionnaire was given to women attending either an ISHC or a FP-only clinic. Results One hundred questionnaires that fulfilled the inclusion criteria were returned. The users of FP-only services were generally older than the users of ISHCs and were more likely than the users of ISHCs to classify themselves as UK white. Stigma perception was significantly higher for the ISHC than the FP-only clinic. Conclusion The results of this research indicate that among women who request contraception only, perceived stigma is higher when they attend an ISHC than when they attend a FP-only clinic. As this survey only enrolled clinic users, the authors were unable to assess whether integration generates sufficient stigma to deter some women from accessing contraception from integrated services. Of all stigma-related issues, disclosure concerns are likely to be the most important to the service user. Stigma is not an issue of overriding concern for most service users.
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Affiliation(s)
- Ulrike Sauer
- Department of Reproductive and Sexual Health Services, Enfield Community Services, London, UK
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22
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Priorities for young adults when accessing UK primary care: literature review. Prim Health Care Res Dev 2012; 14:341-9. [PMID: 23092551 DOI: 10.1017/s1463423612000497] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This literature review focuses on what matters to young adults when they access primary care services in the United Kingdom. Patients' access to and experience of primary care services differs across age groups. Existing research has largely focused on the needs and experiences of children, adolescents, and adults. There is some evidence to suggest the views of young adults (aged 18-25 years) that may differ from the views of other age groups, and research has not previously reported specifically on the views of this group of the population. The literature was reviewed to identify the views and priorities of young UK adults regarding primary healthcare provision, and furthermore, to identify those related topics that would benefit from further research. Relevant academic publications and grey literature published from 2000 onwards was reviewed and synthesised. We identified and reported emerging themes that were of importance to young adults in respect of the UK primary care provision. A total of 19 papers met our inclusion criteria. Young adults access primary care services less frequently than other age groups; this may be because of their experience of primary care throughout childhood and adolescence. Five aspects of primary care provision emerged as being of importance to young adults--the accessibility and availability of services, the confidentiality of health-related information, issues relating to communication with healthcare professionals, continuity of care, and behaviours and attitudes expressed towards young adults by healthcare professionals. There is a lack of focus of current research on the expectations, needs, and primary healthcare experiences of young adults. Young adults may hold views that are distinct from other age groups. Further research is needed to better understand the needs of a young adult population as their needs may impact the future use of services.
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Llewellyn C, Pollard A, Miners A, Richardson D, Fisher M, Cairns J, Smith H. Understanding patient choices for attending sexually transmitted infection testing services: a qualitative study. Sex Transm Infect 2012; 88:504-9. [PMID: 22628665 PMCID: PMC3595495 DOI: 10.1136/sextrans-2011-050344] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To establish which aspects of sexually transmitted infection (STI) testing services are important to STI testing service users. Methods 10 focus groups consisting of previous or existing users of STI testing services were conducted in community settings in the south east of England. Groups were quota sampled based on age, gender and sexual orientation. Data were analysed using Framework Analysis. Results 65 respondents (58% men) participated. Perceived expertise of staff was the key reason for attendance at genitourinary medicine services rather than general practice. Although some respondents voiced a willingness to test for STIs within general practice, the apparent limited range of tests available in general practice and the perceived lack of expertise around sexual health appeared to discourage attendance at general practice. The decision of where to test for STIs was also influenced by past experience of testing, existing relationships with general practice, method of receiving test results and whether the patient had other medical conditions such as HIV. Conclusions No one type of STI testing service is suitable for all patients. This is recognised by policymakers, and it now requires commissioners and providers to make services outside of genitourinary medicine clinics more acceptable and attractive to patients, in particular to address the perceived lack of expertise and limited range of STIs tests available at alternative testing sites.
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Affiliation(s)
- Carrie Llewellyn
- Division of Public Health & Primary Care, Brighton & Sussex Medical School, Mayfield House, Falmer, Brighton BN1 9PH, UK.
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Carter MW, Kraft JM, Hatfield-Timajchy K, Hock-Long L, Hogben M. STD and HIV testing behaviors among black and Puerto Rican young adults. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2011; 43:238-246. [PMID: 22151511 DOI: 10.1363/4323811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS Data from a 2007-2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self-reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18-25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority-86%-perceived their risk of STD infection in the next year as "not at all likely." Sixty-one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized.
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Affiliation(s)
- Marion W Carter
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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25
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Brugha R, Balfe M, Conroy RM, Clarke E, Fitzgerald M, O'connell E, Jeffares I, Vaughan D, Fleming C, O'donovan D. Young adults’ preferred options for receiving chlamydia screening test results: a cross-sectional survey of 6085 young adults. Int J STD AIDS 2011; 22:635-9. [DOI: 10.1258/ijsa.2011.010482] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- R Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - M Balfe
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - R M Conroy
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - E Clarke
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - M Fitzgerald
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - E O'connell
- Department of Health Promotion, Clinical Science Institute, National University of Ireland, Galway, Republic of Ireland
| | - I Jeffares
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin
| | - D Vaughan
- Department of Health Promotion, Clinical Science Institute, National University of Ireland, Galway, Republic of Ireland
| | - C Fleming
- Department of Health Promotion, Clinical Science Institute, National University of Ireland, Galway, Republic of Ireland
| | - D O'donovan
- Department of Health Promotion, Clinical Science Institute, National University of Ireland, Galway, Republic of Ireland
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Hood JE, Friedman AL. Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections. Sex Health 2011; 8:159-70. [PMID: 21592429 DOI: 10.1071/sh10070] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 08/24/2010] [Indexed: 11/23/2022]
Abstract
Stigma has long accompanied sexually transmissible infections (STI) and hindered prevention and control efforts. It not only acts as a formidable barrier to STI testing, treatment and disclosure, but has a multitude of consequences for the health and quality of life of infected individuals. This review summarises the literature related to STI stigma and offers practical approaches to counter STI-associated stigma through multi-level efforts. Specifically, it describes the key sources that breed and perpetuate stigma, outlines how STI-associated stigma has been conceptualised and measured in the literature, documents the impact of stigma on infected and uninfected individuals, and summarises the stigma reduction strategies recommended in the literature. Gaps in the literature are identified and areas for further research are suggested, along with practical strategies for moving forward.
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Affiliation(s)
- Julia E Hood
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E, Mailstop E-44, Atlanta, GA 30333, USA.
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27
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Tan TPY, Stokes T, Shaw EJ. Use of qualitative research as evidence in the clinical guideline program of the National Institute for Health and Clinical Excellence. INT J EVID-BASED HEA 2011; 7:169-72. [PMID: 21631857 DOI: 10.1111/j.1744-1609.2009.00135.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe the use of qualitative research as evidence in a national clinical guideline program (National Institute for Health and Clinical Excellence - NICE, UK) and to identify training needs for guideline developers. METHODS All published NICE clinical guidelines from December 2002 to June 2007 were reviewed to determine whether qualitative studies were considered as evidence in the development of recommendations and how this type of evidence had been used. Developers of clinical guidelines due to be published between July 2007 and March 2008 were asked to describe their training needs regarding the use of qualitative research in clinical guidelines. Data were summarised using simple descriptive statistics. RESULTS Of the 49 clinical guidelines published by NICE within the study period, nearly half (45%, 22/49) used qualitative studies as an evidence base for developing recommendations for clinical practice. The number of qualitative studies used in these clinical guidelines increased from 2003 to 2006: 9 studies in 2003; 41 studies in 2004; 60 studies in 2005; 139 studies in 2006. In terms of how qualitative evidence was used in the guidelines, the study identified the following main issues: inconsistencies in the terminology used to describe types of qualitative study design; lack of standardised search strategies and/or targeted processes to select studies from databases; lack of a standardised approach to quality appraisal and poor reporting of how the identified evidence was used to inform the relevant guideline recommendations. Of the 17 clinical guidelines in development during the study period, the questionnaire was returned by approximately half of the guideline developers (response rate 47%, 8/17). A wide range of training needs was identified, chiefly training in the identification, quality appraisal and synthesis of qualitative studies and guidance as to the guideline areas where qualitative studies should be considered as evidence. CONCLUSION Qualitative research is increasingly being used by NICE's clinical guideline developers as an evidence base to generate clinical practice recommendations. There are, however, clear training needs for NICE's guideline developers in terms of how best to identify, quality appraise and synthesise qualitative evidence for use in evidence-based clinical guidelines.
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Affiliation(s)
- Toni P Y Tan
- National Institute for Health and Clinical Excellence, Manchester, UK.
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Akande V, Turner C, Horner P, Horne A, Pacey A. Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice. HUM FERTIL 2010; 13:115-25. [PMID: 20849196 PMCID: PMC3069694 DOI: 10.3109/14647273.2010.513893] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified.
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Affiliation(s)
- Valentine Akande
- Bristol Centre for Reproductive Medicine, Southmead Hospital, Bristol, UK.
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Balfe M, Brugha R, O' Donovan D, O' Connell E, Vaughan D. Triggers of self-conscious emotions in the sexually transmitted infection testing process. BMC Res Notes 2010; 3:229. [PMID: 20716339 PMCID: PMC2930645 DOI: 10.1186/1756-0500-3-229] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/17/2010] [Indexed: 11/10/2022] Open
Abstract
Background Self-conscious emotions (shame, guilt and embarrassment) are part of many individuals' experiences of seeking STI testing. These emotions can have negative impacts on individuals' interpretations of the STI testing process, their willingness to seek treatment and their willingness to inform sexual partners in light of positive STI diagnoses. Because of these impacts, researchers have called for more work to be completed on the connections between shame, guilt, embarrassment and STI testing. We examine the specific events in the STI testing process that trigger self-conscious emotions in young adults who seek STI testing; and to understand what it is about these events that triggers these emotions. Semi-structured interviews with 30 adults (21 women, 9 men) in the Republic of Ireland. Findings Seven specific triggers of self-conscious emotions were identified. These were: having unprotected sex, associated with the initial reason for seeking STI testing; talking to partners and peers about the intention to seek STI testing; the experience of accessing STI testing facilities and sitting in clinic waiting rooms; negative interactions with healthcare professionals; receiving a positive diagnosis of an STI; having to notify sexual partners in light of a positive STI diagnosis; and accessing healthcare settings for treatment for an STI. Self-conscious emotions were triggered in each case by a perceived threat to respondents' social identities. Conclusion There are multiple triggers of self-conscious emotions in the STI testing process, ranging from the initial decision to seek testing, right through to the experience of accessing treatment. The role of self-conscious emotions needs to be considered in each component of service design from health promotion approaches, through facility layout to the training of all professionals involved in the STI testing process.
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Affiliation(s)
- Myles Balfe
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Fronteira I, Oliveira da Silva M, Unzeitig V, Karro H, Temmerman M. Sexual and reproductive health of adolescents in Belgium, the Czech Republic, Estonia and Portugal. EUR J CONTRACEP REPR 2009; 14:215-20. [PMID: 19565419 DOI: 10.1080/13625180902894524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This pilot study, within the REPROSTAT 2 Project, aimed at investigating the sexual and reproductive health (SRH) of school-based youths in four countries of the European Union. METHODS Students of either sex, aged between 16 and 19 years and entering grade 10, 11 or 12 during the 2005-2006 school year participated in a cross sectional survey. A structured questionnaire was administered to a convenience sample of students from selected schools in Belgium, the Czech Republic, Estonia and Portugal. RESULTS In each country, more than three quarters of respondents had previously had a boyfriend or girlfriend and almost half had heterosexual intercourse. More than 85% of sexually experienced youths in each country had used contraception at coital debut. Mean age at coital debut varied between 15.2 (Belgium) and 16.4 years (Czech Republic). While 51% of respondents in Estonia knew of Chlamydia trachomatis infection, the corresponding figure in Portugal was only 12%. CONCLUSIONS Sexual activity is common among school-going youths in all four countries. This highlights the need for Member States to systematically collect indicators of SRH in this population. Use of a common measurement framework can inform the establishment of common targets for joint initiatives such as reducing teenage pregnancy and STIs in adolescents.
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Affiliation(s)
- Inês Fronteira
- Health Systems Unit, Instituto de Higiene e Medicina Tropical, Rua da Junqueira, 96, Lisboa 1349-008, Portugal.
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Balfe M, Brugha R. What prompts young adults in Ireland to attend health services for STI testing? BMC Public Health 2009; 9:311. [PMID: 19709430 PMCID: PMC2907522 DOI: 10.1186/1471-2458-9-311] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 08/26/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In-depth understanding of the factors that prompt young adults to attend health services for sexually transmitted infection (STI) testing are needed to underpin sexual health programes. We conducted a qualitative study to identify and explore why young adults (18-29 years) in Ireland attended specialist and community health services for STI testing; the factors that supported/undermined their decisions to seek STI testing; and any factors that led to delay in seeking STI testing. METHODS Semi-structured interviews with 30 adults (21 women, 9 men). Young adults were recruited from General Practice (GP) practices, Third Level College health services, Family Planning clinics and specialist STI treatment services for men who have sex with men (MSM). Interview questions examined why respondents decided to go for STI testing, whether they acted upon this desire immediately or decided to wait, and what they felt were important barriers/enablers to their health-seeking attempts. Interviews were thematically analyzed using standard qualitative techniques. RESULTS Respondents sought STI testing for one of four reasons: they had reached a transitional moment in their lives (they were either about to stop using condoms with their sexual partner or were emerging from a period of their lives where they had a series of risky sexual relationships); they had had unprotected sex with a casual partner; they had symptoms of infection; and/or they were required to do so by their employer. Catalytic factors included media and government health promotion campaigns and knowing someone with an STI. However, many respondents delayed seeking testing. Reasons included respondents' concerns about stigma and that they would be judged by healthcare professionals, and feelings of invulnerability. Importantly, several respondents who waited up to four weeks to make an appointment after their initial decision to seek STI testing did not view this as delay. CONCLUSION Sexual health promotion campaigns for young people should address the reasons why they delay testing, specifically through measures to avoid stigma (supply-side) and reassure young adults (demand-side). Strategies to increase testing-uptake should focus on these four key opportunities - young adults leaving relationships, those entering relationships where condoms will not be used, those who have had unprotected sex and those with STI-related symptoms.
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Affiliation(s)
- Myles Balfe
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.
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Schwartz RM, Hogben M, Liddon N, Augenbraun M, McCormack WM, Rubin S, Wilson TE. Coping with a diagnosis of C trachomatis or N gonorrhoeae: psychosocial and behavioral correlates. J Health Psychol 2009; 13:921-9. [PMID: 18809643 DOI: 10.1177/1359105308095066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current study sought to add to the stress and coping literature by examining whether coping responses are elicited from a diagnosis of chlamydia or gonorrhea and, if so, whether active or passive coping responses are associated with particular psychological factors and prevention behaviors. Data from 259 urban, minority participants recently diagnosed with chlamydia or gonorrhea were analyzed. Results indicated that denial was associated with having more baseline depressive symptoms and with having more one-time partners at follow-up. Problem-focused coping was associated with more consistent condom use at follow-up. Important sex and ethnicity differences were found. Intervention implications are discussed.
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Rusch MLA, Shoveller JA, Burgess S, Stancer K, Patrick DM, Tyndall MW. Preliminary development of a scale to measure stigma relating to sexually transmitted infections among women in a high risk neighbourhood. BMC WOMENS HEALTH 2008; 8:21. [PMID: 19021915 PMCID: PMC2610028 DOI: 10.1186/1472-6874-8-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 11/20/2008] [Indexed: 11/24/2022]
Abstract
Background As stigma is a socially constructed concept, it would follow that stigma related to sexual behaviours and sexually transmitted infections would carry with it many of the gender-based morals that are entrenched in social constructs of sexuality. In many societies, women tend to be judged more harshly with respect to sexual morals, and would therefore have a different experience of stigma related to sexual behaviours as compared to men. While a variety of stigma scales exist for sexually transmitted infections (STIs) in general; none incorporate these female-specific aspects. The objective of this study was to develop a scale to measure the unique experience of STI-related stigma among women. Methods A pool of items was identified from qualitative and quantitative literature on sexual behaviour and STIs among women. Women attending a social evening program at a local community health clinic in a low-income neighbourhood with high prevalence of substance use were passively recruited to take part in a cross-sectional structured interview, including questions on sexual behaviour, sexual health and STI-related stigma. Exploratory factor analysis was used to identify stigma scales, and descriptive statistics were used to assess the associations of demographics, sexual and drug-related risk behaviours with the emerging scales. Results Three scales emerged from exploratory factor analysis – female-specific moral stigma, social stigma (judgement by others) and internal stigma (self-judgement) – with alpha co-efficients of 0.737, 0.705 and 0.729, respectively. In this population of women, internal stigma and social stigma carried higher scores than female-specific moral stigma. Aboriginal ethnicity was associated with higher internal and female-specific moral stigma scores, while older age (>30 years) was associated with higher female-specific moral stigma scores. Conclusion Descriptive statistics indicated an important influence of culture and age on specific types of stigma. Quantitative researchers examining STI-stigma should consider incorporating these female-specific factors in order to tailor scales for women.
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Affiliation(s)
- Melanie L A Rusch
- Division of International Health and Cross Cultural Medicine, University of California San Diego, La Jolla, USA.
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Association of sexually transmitted disease-related stigma with sexual health care among women attending a community clinic program. Sex Transm Dis 2008; 35:553-7. [PMID: 18434941 DOI: 10.1097/olq.0b013e3181685855] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to assess the association of sexually transmitted disease (STD)-related stigma on sexual health care behaviors, including Papanicolaou smears and STD testing/treatment, among women from a high-risk community. METHODS Descriptive statistics were used to assess the association of demographics, sexual and drug-related risk behaviors, and 3 measures of STD-stigma (internal, social, and tribal stigma, the latter referring to "tribes" of womanhood) with sexual health care in the past year. Pearson's chi-square test and Mann-Whitney test were used to assess significance. Multivariate logistic models were used to determine the association of STD-stigma with sexual health care after controlling for other factors. RESULTS Lower internal stigma score was marginally associated with reporting an STD test in the past year [median score (interquartile range) for those reporting and not reporting an STD test were 0.79 (0.30-1.59) and 1.35 (0.67-1.93), respectively]. In an adjusted model, internal stigma retained a negative association with reporting of STD testing in the past year (adjusted odds ratio, 0.92; 95% confidence interval, 0.85-0.99). DISCUSSION Most women had received a Papanicolaou smear in the past year, and none of the STD-stigma scales were associated with reporting this behavior. Internal stigma retained an association with not having any STD test or treatment. Although sexual stigma is a deeply rooted social construct, paying attention to how prevention messages and STD information are delivered may help remove one barrier to sexual health care.
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Pavlin NL, Parker R, Fairley CK, Gunn JM, Hocking J. Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice. BMC Infect Dis 2008; 8:62. [PMID: 18471280 PMCID: PMC2394525 DOI: 10.1186/1471-2334-8-62] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 05/09/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australia is developing a chlamydia screening program. This study aimed to determine the attitudes of young women to the introduction of chlamydia screening in Australian General Practice. METHODS In-depth face-to-face interviews with 24 young women from across Victoria, Australia, attending a randomly selected sample of general practices. RESULTS Young women reported that they would accept age-based screening for chlamydia in general practice, during both sexual-health and non-sexual-health related consultations. Trust in their general practitioner (GP) was reported to be a major factor in the acceptability of chlamydia screening. The women felt chlamydia screening should be offered to all young women rather than targeted at "high risk" women based on sexual history and they particularly emphasised the importance of normalising chlamydia screening. The women reported that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test. Some reported that they would lie if asked how many partners they had had CONCLUSION Women do not want a sexual history taken when being asked to have a chlamydia test while attending a general practitioner. They prefer the offer of chlamydia screening to be based on age rather than assessment of sexual risk. Chlamydia screening needs to be normalised and destigmatised.
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Affiliation(s)
- Natasha L Pavlin
- Department of General Practice, University of Melbourne, Victoria, Australia.
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Baraitser P, Pearce V, Walsh N, Cooper R, Brown KC, Holmes J, Smith L, Boynton P. Look who's taking notes in your clinic: mystery shoppers as evaluators in sexual health services. Health Expect 2008; 11:54-62. [PMID: 18275402 DOI: 10.1111/j.1369-7625.2007.00467.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To test the feasibility of professional patients as a tool for sexual health service evaluation. Professional patients are paid to use services specifically for audit or evaluation purposes without disclosing their identity as evaluators. METHODS Professional patients visited five large sexual health departments used by 3000 clients per week in two inner London Boroughs with very high rates of sexual ill health. They recorded their experience on a structured evaluation form. Semi-structured telephone interviews were completed with seven service providers to document their experience of the programme. RESULTS Recruitment and training for professional patients is described. Forty professional patients made 105 visits during two rounds of visits 9 months apart. After 47% (round 1) and 62% (round 2) of visits, the professional patients felt that they would recommend the service to a friend. The professional patients provided detailed and specific feedback on all aspects of service provision. This information was highly valued by service providers who reported few objections from staff to the visits. A small number of examples of very poor care were documented. CONCLUSIONS Professional patients are a useful tool for sexual health service evaluation. They provide high quality feedback because they are both 'experts' on sexual health service provision and users of sexual health services. This method of evaluation raises ethical issues about the acceptability of deception as part of the evaluation process, the right of staff to anonymity and to refuse to be visited. Professional patient programmes provide an opportunity for regular cycles of user feedback to monitor quality improvement.
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Affiliation(s)
- Paula Baraitser
- Lambeth and Southwark Sexual Health Modernization Programme, London, UK.
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Nguyen MN, Venne T, Rodrigues I, Jacques J. Why and According to What Consultation Profiles Do Female Sex Workers Consult Health Care Professionals? A Study Conducted in Laval, Québec. Health Care Women Int 2008; 29:165-82. [DOI: 10.1080/07399330701738226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Patel H, Baeza J, Patel M, Greene L, Theobald N. Improving sexual health services in the city: can the NHS learn from clients and the service industry. Health Expect 2007; 10:139-47. [PMID: 17524007 PMCID: PMC5060393 DOI: 10.1111/j.1369-7625.2006.00428.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Genitourinary service providers are struggling to meet patient demand and have introduced changes in access structure to cope. In this study, we explored the perspectives of clients and providers upon the different models of access introduced and whether these maintained service quality using the SERQUAL model. METHODS Primary data were collected in May 2005 at two genitourinary medicine clinics, two Accident and Emergency Departments and from members of a university 'gay' society all of which were located in London. Forty-four high-risk clients and 11 health service providers underwent semi-structured face-to-face interviews. RESULTS Both the walk-in and appointment-based access systems were appreciated by clients. Clients said that the most important issue was that they were not turned away when they presented. Health-care providers had a variety of opinions about the two systems as they had different impacts on morale, training and service provision. CONCLUSIONS Service quality can be maintained by using both walk-in and appointment-based systems. This is because our data, in line with Parasuraman's model of service quality, showed that 'access' is but one determinant of quality. Having different modes of access facilitates patient choice, which is paramount in a modern health-care system. However, to provide a good service it is important to maintain a motivated staff, who can be affected by their working environment.
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Affiliation(s)
- Hitesh Patel
- Foundation Year One Doctor, Chelsea and Westminster Hospital, London
| | - Juan Baeza
- Lecturer in Health Policy, Tanaka Business School, Imperial College, London
| | - Mitesh Patel
- Senior House Officer, Kings College Hospital, London
| | - Linda Greene
- Consultant Physician, Jefferiss Wing, St Mary's Hospital, London
| | - Nick Theobald
- Associate Specialist in GUM, Chelsea and Westminster Hospital, London, UK
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Grulich AE, de Visser RO, Smith AMA, Rissel CE, Richters J. Sex in Australia: Sexually transmissible infection and blood-borne virus history in a representative sample of adults. Aust N Z J Public Health 2007; 27:234-41. [PMID: 14696717 DOI: 10.1111/j.1467-842x.2003.tb00814.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the lifetime and recent history of STIs and BBV, including place of seeking treatment, in a representative sample of Australian adults. METHODS Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). RESULTS Overall, 20.2% of men and 16.9% of women had ever been diagnosed with an STI or BBV, and 2.0% and 2.2% respectively had been diagnosed in the past year. The participant's usual general practitioner was the most common location of treatment. Sexual health clinics accounted for a small proportion of treatment locations. Predictors of recent STI or BBV diagnosis in men included homosexual or bisexual identity, a history of sex work as a worker or client, a history of injecting drugs and having more than one partner in the past year. In women, predictors included bisexual identity, history of sex work as a worker, injecting drug use, and having more than one partner in the past year. Around 40% of men and women had been tested for HIV and in homosexually identified men, 77% had been tested. CONCLUSION STIs and BBVs are common infections in Australia and care is mostly received from general practitioners. Although a variety of predictors, including homosexual or bisexual identity, injecting drug use and sex work were related to STI diagnosis, STIs were not uncommon among people without these risk factors. IMPLICATIONS General practitioners in Australia require a high level of expertise to recognise, offer testing, and manage common STIs and BBVs.
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Affiliation(s)
- Andrew E Grulich
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst.
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Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care 2007; 16:303-7. [PMID: 17693680 PMCID: PMC2464947 DOI: 10.1136/qshc.2006.020883] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Chlamydia trachomatis infection is a common sexually transmitted infection with serious sequelae. Excellent access to testing, treatment and contact tracing are an essential part of strategies to control it. With traditional sexual health services over-stretched, community pharmacies are well placed to provide this service. They have the potential to improve access by offering chlamydia testing and treatment from high street venues with long opening hours. This study evaluated the feasibility and acceptability to users and pharmacists of this service in independent community pharmacies. METHOD A chlamydia testing and treatment service was offered in three community pharmacies in two inner London boroughs for a 3-month pilot. Data on the feasibility and acceptability of the new service were collected via a survey of client experience, in-depth semistructured interviews with clients and pharmacists, and structured evaluation reports completed by professional patients paid to visit the pharmacies. RESULTS 83 tests were taken with eight (9.5%) of these positive for C trachomatis. Of those tested, 94% (n = 73) were women and 71% (n = 56) were from ethnic minorities. 80 clients completed the questionnaires and 24 clients were interviewed. Most clients heard about the service from the pharmacist when requesting emergency contraception and 16% (n = 13) would not otherwise have been tested. Clients valued the speed and convenience of the service and the friendly, non-judgmental approach of the pharmacist. Confidentiality when asking for the service at the counter was suboptimal, and the pharmacist trained to deliver the service was not always available to provide it. CONCLUSIONS Chlamydia testing and treatment in community pharmacies is feasible and acceptable to users. The service increases access among young women at high risk of sexually transmitted infection but not among young men.
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Affiliation(s)
- P Baraitser
- Lambeth and Southwark Sexual Health Modernisation Programme, London, UK.
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41
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Pavlin NL, Gunn JM, Parker R, Fairley CK, Hocking J. Implementing chlamydia screening: what do women think? A systematic review of the literature. BMC Public Health 2006; 6:221. [PMID: 16948838 PMCID: PMC1569845 DOI: 10.1186/1471-2458-6-221] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 09/01/2006] [Indexed: 11/17/2022] Open
Abstract
Background Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. Methods Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. Eligibility criteria: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. Results From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. Conclusion Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.
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Affiliation(s)
- Natasha L Pavlin
- Department of General Practice, Melbourne University, 200 Berkeley St, Carlton, Melbourne, Australia
| | - Jane M Gunn
- Department of General Practice, Melbourne University, 200 Berkeley St, Carlton, Melbourne, Australia
| | - Rhian Parker
- Department of General Practice, Melbourne University, 200 Berkeley St, Carlton, Melbourne, Australia
| | - Christopher K Fairley
- School of Population Health, Melbourne University, Carlton, Melbourne, Australia
- Melbourne Sexual Health Centre (MSHC), 580 Swanston St, Carlton, Melbourne, Australia
| | - Jane Hocking
- School of Population Health, Melbourne University, Carlton, Melbourne, Australia
- Centre for Epidemiology and Population Health Research, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3001, Australia
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Piercy H. "It feels good to be told that I'm all clear": patients' accounts of retesting following genital chlamydial infection. Sex Transm Infect 2006; 82:330-3. [PMID: 16877587 PMCID: PMC2564724 DOI: 10.1136/sti.2005.018838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the meaning that people with genital chlamydial infection attribute to retesting as part of their treatment management. METHODS Unstructured interviews with 50 heterosexual patients (40 female and 10 male) who had or had had genital chlamydia infection. Recruitment was via a genitourinary medicine clinic and a contraceptive clinic. RESULTS The return visit was understood in terms of the retest. The retest occupied a pivotal position in the infection experience and was invested with symbolic significance because it provided a means by which to deal with feelings of bodily pollution. It marked the end of dirtiness that was important for the restoration of identity. It also marked the beginning of cleanness that was important in relation to sexual relationships. CONCLUSION The sociocultural construction of sexually transmitted infections shapes the individual experience of having chlamydial infection. This perspective sheds light on the meaning that individuals invest in aspects of infection management. It is important for some people to know rather than assume that their infection has been eliminated, a function that is fulfilled by the retest. When retesting is not available, individuals may use increasingly available opportunistic chlamydia testing for this purpose with consequent cost and resource implications.
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Affiliation(s)
- H Piercy
- School of Nursing and Midwifery, University of Sheffield, Winter Street, Sheffield S3 7ND, UK.
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Campbell R, Mills N, Sanford E, Graham A, Low N, Peters TJ. Does population screening for Chlamydia trachomatis raise anxiety among those tested? Findings from a population based chlamydia screening study. BMC Public Health 2006; 6:106. [PMID: 16638147 PMCID: PMC1459135 DOI: 10.1186/1471-2458-6-106] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 04/25/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The advent of urine testing for Chlamydia trachomatis has raised the possibility of large-scale screening for this sexually transmitted infection, which is now the most common in the United Kingdom. The purpose of this study was to investigate the effect of an invitation to be screened for chlamydia and of receiving a negative result on levels of anxiety, depression and self-esteem. METHODS 19,773 men and women aged 16 to 39 years, selected at random from 27 general practices in two large city areas (Bristol and Birmingham) were invited by post to send home-collected urine samples or vulvo-vaginal swabs for chlamydia testing. Questionnaires enquiring about anxiety, depression and self-esteem were sent to random samples of those offered screening: one month before the dispatch of invitations; when participants returned samples; and after receiving a negative result. RESULTS Home screening was associated with an overall reduction in anxiety scores. An invitation to participate did not increase anxiety levels. Anxiety scores in men were lower after receiving the invitation than at baseline. Amongst women anxiety was reduced after receipt of negative test results. Neither depression nor self-esteem scores were affected by screening. CONCLUSION Postal screening for chlamydia does not appear to have a negative impact on overall psychological well-being and can lead to a decrease in anxiety levels among respondents. There is, however, a clear difference between men and women in when this reduction occurs.
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Affiliation(s)
- Rona Campbell
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, BRISTOL BS8 2PR, UK
| | - Nicola Mills
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, BRISTOL BS8 2PR, UK
| | - Emma Sanford
- Bedfordshire and Hertfordshire Strategic Health Authority, 63-77 Victoria Street, St Albans, Herts. AL1 3ER, UK
| | - Anna Graham
- Department of Community Based Medicine, University of Bristol, 1 The Grange, Woodland Road, Bristol, BS8 1AU, UK
| | - Nicola Low
- Department of Social and Preventive Medicine, University of Berne, Finkenhubelweg 11, 3012 Berne, Switzerland
| | - Tim J Peters
- Department of Community Based Medicine, University of Bristol, 1 The Grange, Woodland Road, Bristol, BS8 1AU, UK
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Clarke J, Christodoulides H, Taylor Y. Supply and demand: estimating the real need for care while meeting the 48 hour waiting time target in a genitourinary medicine clinic by a closed appointment system. Sex Transm Infect 2006; 82:45-8. [PMID: 16461602 PMCID: PMC2563836 DOI: 10.1136/sti.2005.018358] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To attempt to assess demand for access to sexual health services in a community where a "closed" appointment system operates in the local genitourinary medicine (GUM) clinic. SETTING A large GUM clinic serving a provincial city in England. Appointments for new episodes are available only 1 or 2 days ahead. Service user complaints about repeated difficulty in getting through to book a visit prompted a review of all methods of access. METHODS A prospective review of all calls received in the departmental telephone booking service was performed. Temporary extra staff manned a cascade sequence of telephone lines and recorded all calls and caller characteristics such as age and declaration of symptoms. All attempts to book an appointment in person, by written referral, or by telephone in a period of 5 working days were also logged. This total demand was compared with the actual capacity and maximum theoretical capacity of the clinic during the same time period. RESULTS 626 appointments would be required in the working week to accommodate all patients within 48 hours of requesting to be seen. 84% of all calls requested a new appointment, and 77% all new appointment requests were by phone. There were 181 new appointments available; 72% of those requesting an appointment could not be seen. The clinic was working at 103% capacity. To accommodate demand at this quiet time of the academic year, the GUM service would need to increase capacity by 3-4-fold. CONCLUSIONS Closed appointment systems in GUM services may produce an apparent "improvement" in waiting times to 48 hours, but many callers are not able to book an appointment at all. Demand for GUM services outstrips capacity to an extent that internal efficiency savings cannot hope to address.
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Affiliation(s)
- J Clarke
- Department of Genitourinary Medicine, Centre for Sexual Health, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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Reid RJ, Scholes D, Grothaus L, Truelove Y, Fishman P, McClure J, Grafton J, Thompson RS. Is provider continuity associated with chlamydia screening for adolescent and young adult women? Prev Med 2005; 41:865-72. [PMID: 16169069 DOI: 10.1016/j.ypmed.2005.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 07/31/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Longitudinal patient-provider relationships are a cornerstone of primary care. For many prevention services, better continuity of provider has been associated with better adherence to recommended practice. Our objective was to examine the relationship between continuity of care and chlamydia screening in adolescent and young women, a preventive service where large performance gaps exist. METHODS The study population included 4117 sexually active women aged 14-25 years continuously enrolled at a large U.S. HMO. Administrative data from 2000 to 2002 were used to document chlamydia testing, provider continuity, and selected covariates. We used logistic regression to examine the relationship between provider continuity and chlamydia testing after controlling for potential confounders. RESULTS 57.2% of eligible young women received a chlamydia test over the 2-year period. After controlling for utilization and other confounders, we found women in the lowest continuity of care quartile had 41% greater odds of being tested than those in the highest quartile (OR 1.41, 95% CI 1.14-1.76). CONCLUSIONS For adolescents and young women, the likelihood of testing for chlamydia was reduced when care was concentrated with a usual provider. Potential implications for health service delivery are discussed.
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Affiliation(s)
- Robert J Reid
- Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
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El-Kak F, Jurdi R, Kaddour A, Zurayk H. Gender and sexual health in clinical practice in Lebanon. Int J Gynaecol Obstet 2005; 87:260-6. [PMID: 15548405 PMCID: PMC1457111 DOI: 10.1016/j.ijgo.2004.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 08/09/2004] [Accepted: 08/13/2004] [Indexed: 10/26/2022]
Abstract
This study examines the readiness of obstetricians/gynecologists (Ob/Gyns) in Lebanon to provide sexual consultation, their degree of comfort when discussing issues of sexual health, and their attitudes regarding assessment, treatment, and referral. Data on these concepts were collected through face-to-face interviews with 286 randomly selected Ob/Gyns. Most Ob/Gyns reported feeling comfortable discussing sexuality during consultations, which they attributed much more to professional experience than to training. Most Ob/Gyns reported giving proper time for management of sexual health issues and follow-up, as these issues are brought up frequently by their women clients. However, results suggest that only one-third (31%) of Lebanese Ob/Gyns nearly always take the initiative in asking patients about their sexual health. Moreover, almost 45% of participating Ob/Gyns did not recognize a strong relationship between reproductive health and sexual functioning. Gender was not found to be an important predictor for any of the indicators measured in the present study. Ob/Gyns in Lebanon are significant consultants on various sexual issues, and they need better postgraduate training, continuing medical education, and access to medical congress resources on the topic of sexuality and its relationship to reproductive health.
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Affiliation(s)
- F El-Kak
- Department of Health Education and Behavior, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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van Valkengoed IGM, Morré SA, van den Brule AJC, Meijer CJLM, Bouter LM, van Eijk JTM, Boeke AJP. Follow-up, treatment, and reinfection rates among asymptomatic chlamydia trachomatis cases in general practice. Br J Gen Pract 2002; 52:623-7. [PMID: 12171219 PMCID: PMC1314379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Adequate treatment and follow-up of patients is essential to the success of a screening programme for Chlamydia trachomatis. There has been a lack of data on follow-up, confirmation of infections, and reinfection rates among asymptomatic patients in general practice. AIM 7b study the rates of diagnostic confirmation of C trachomatis infection, successful treatment, and reinfection one year after cases were detected in a screening programme for asymptomatic infections. DESIGN OF STUDY Prospective cohort study SETTING Fifteen general practices in Amsterdam, The Netherlands. METHOD One hundred and twenty-four patients with asymptomatic C trachomatis infections were requested to provide a cervical or urethral swab and a urine specimen, for the purpose of diagnostic confirmation before being treated. One year after the first screening, all of the patients were invited for a second screening. All samples were tested using the ligase chain reaction (Abbott Laboratories, Chicago, USA). RESULTS Out of 124 patients, 110 (89%) attended the scheduled appointment for diagnostic confirmation and treatment; 92 (84%) of them were confirmed to be positive and received treatment. At the second screening a year later, none of the 56 patients who had received treatment and who had been screened a second time were reinfected. CONCLUSION No asymptomatic patients werefound to have reinfections with C trachomatis one year after diagnostic confirmation and treatment. This underlines the effectiveness of the screening and treatment strategy
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Power R. The application of qualitative research methods to the study of sexually transmitted infections. Sex Transm Infect 2002; 78:87-9. [PMID: 12081190 PMCID: PMC1744432 DOI: 10.1136/sti.78.2.87] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Qualitative methods have gained support in health sciences research and have a role to play in STI studies. This article reviews the main techniques used by qualitative researchers, with illustrations taken from the field of STIs.
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Affiliation(s)
- R Power
- Department of STDs, Royal Free and University College London, UK.
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