Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: qualitative process evaluation of the “Test n Treat” trial

Abstract

Background: Low uptake of sexually transmitted infection testing by sexually active young people is a worldwide public health problem. Screening in non-medical settings has been suggested as a method to improve uptake. The "Test n Treat" feasibility trial offered free, on-site rapid chlamydia/gonorrhoea tests with same day treatment for chlamydia (and gonorrhoea treatment at a local clinic,) to sexually active students (median age 17 years) at six technical colleges in London. Despite high rates of chlamydia (6% prevalence), uptake of testing was low (< 15%). In a qualitative study we explored the acceptability, including barriers and facilitators to uptake, of on-site chlamydia screening. Methods: In 2016-17 we conducted a qualitative study in the interpretative tradition using face to face or telephone semi-structured interviews with students (n = 26), teaching staff (n = 3) and field researchers (n = 4). Interviews were digitally recorded, transcribed and thematically analysed. Results: From the student perspective, feelings of embarrassment and the potential for stigma were deterrents to sexually transmitted infection testing. While the non-medical setting was viewed as mitigating against stigma, for some students volunteering to be screened exposed them to detrimental judgements by their peers. A small financial incentive to be screened was regarded as legitimising volunteering in a non-discrediting way. Staff and researchers confirmed these views. The very low level of knowledge about sexually transmitted infections influenced students to not view themselves as candidates for testing. There were also suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky sexual behaviours. Students and researchers reported the strong influence peers had on uptake, or not, of sexually transmitted infection testing.

Alcohol use, cigarette smoking, vaping and number of sexual partners: A cross‐sectional study of sexually active, ethnically diverse, inner city adolescents

“…However, there may be limited visible intervention at the college level that targets such behaviours with tutors reporting that sex education on‐site was very much ‘hit and miss’. Interviews with 26 student participants 12 showed very low levels of knowledge about sexually transmitted infections with only 15% aware that chlamydia can cause infertility. In addition, there were suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky behaviours 12 .…”

“…Interviews with 26 student participants 12 showed very low levels of knowledge about sexually transmitted infections with only 15% aware that chlamydia can cause infertility. In addition, there were suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky behaviours 12 . Young people's lack of knowledge about risky behaviours and sexually transmitted infections is also a problem across Europe, the United States and Australia 11,17,18 …”

“…Four students on the trial steering committee gave advice throughout the study, 26 took part in qualitative interviews, 12 and findings were fed back to participants for their comments during an end of the study workshop.…”

“…In addition, there were suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky behaviours. 12 Young people's lack of knowledge about risky behaviours and sexually transmitted infections is also a problem across Europe, the United States and Australia. 11,17,18 TA B L E 2 Comparison of the prevalence of various lifestyle factors in young people with ≥2 sexual partners versus 0-1 sexual partners in the past year and elsewhere, 5 the UK Department of Health has highlighted the potential benefits of adopting an integrated approach to health improvement by addressing behaviours such as substance use together with sexual behaviours.…”

Consumer-Based STI Screening among Young Adult Women: The Negative Influence of the Social System

“…6,9,10 Sexually transmitted infection diagnoses are associated with feelings of shame, which may cause adverse psychosocial distress, including embarrassment, fear of judgment, guilt, and isolation. 6,10,11 Consequently, self-stigma contributes to delays in screening for STIs. The problematic cycle of social stigma, such as concerns about gossip, partner mistrust, or use of the term "dirty," are barriers to women seeking STI screening.…”