Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

Abstract

Introduction Chlamydia trachomatis (C. trachomatis) infection is the most commonly reported sexually transmitted infection in Sweden and globally. C. trachomatis is often asymptomatic and if left untreated, could cause severe reproductive health issues. In Sweden, men test for C. trachomatis to a lesser extent than women. Aim To explore factors facilitating and constraining Swedish young men’s health care utilization for C. trachomatis detection and treatment. Method A qualitative situational analysis study including data from 18 semi-structured interviews with men (21–30 years). Data collection took place in Stockholm County during 2018. A situational map was constructed to articulate the positions taken in the data within two continuums of variation representing men’s risk perception and strategies to test for C. trachomatis. Results Based on the informants’ risk perception, strategies adopted to test and the role of social support, three different discourses and behaviours towards C. trachomatis testing were identified ranging from a) being indifferent about C. trachomatis -not testing, b) being ambivalent towards testing, to c) being proactive and testing regularly to assure disease free status. Several factors influenced young men’s health care utilization for C. trachomatis detection, where the role of health services and the social support emerged as important factors to facilitate C. trachomatis testing for young men. In addition, endorsing traditional masculinity domains such as leaning on self-reliance, beliefs on invulnerability and framing men as more carefree with their sexual health than women delayed or hindered testing. Conclusion Testing must be promoted among those young men with indifferent or ambivalent discourses. Health systems aiming to increase testing among those at risk should take into consideration the positive role that young men’s social support have, especially the level of social support coming from their peers. Additionally, endorsement of traditional masculinity values may delay or hinder testing.

Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study

“…Our study found that social support was a key factor facilitating STI testing, albeit only for those testing beyond a 12-month period. Our findings are similar to a previous qualitative study in this setting that reported that the association between social support and STI testing varied according to young men's discourses towards it (indifferent, ambiguous, or proactive) [ 49 ]. In Larsson et al’s study, young men who had a proactive attitude towards testing had normalized this behavior and did not need peer support to test.…”

“…It is possible that in our sample, those testing beyond a 12-month period overlapped with those with an ambivalent or indifferent attitude towards testing. We also argue that the same pathways of change described in Larsson et al [ 49 ] apply to our quantitative findings, as Larsson et al's data was collected in the same setting with participants within the same age range and sex.…”

“…In Larsson et al’s study, young men who had a proactive attitude towards testing had normalized this behavior and did not need peer support to test. However, for those with an ambiguous or indifferent stance, having trustworthy peers with whom they could share their concerns facilitated STI testing because trusted peers could provide emotional support, clarify doubts, provide health information, and encourage their friends to test when in need (social influence pathway) [ 49 ]. It is possible that in our sample, those testing beyond a 12-month period overlapped with those with an ambivalent or indifferent attitude towards testing.…”