Title:
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Peer-led intervention to promote chlamydia screening among young people
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Control of chlamydia infections in young people is a public health priority
reflected in a National Screening Programme for 15-24 year olds. However,
effective screening interventions may exacerbate health inequality if uptake is
different across social groups. This thesis aims to i) examine the prevalence and
socioeconomic patterning of chlamydia infections, and ii) conduct formative
research to inform a Peer-Supported Chlamydia Screening intervention.
I conducted a systematic review of chlamydia prevalence in Europe, North
America and Australia and found strong evidence of heterogeneity in prevalence
estimates among 16-24 year olds and mixed evidence of an association between
measures of social disadvantage and higher infection risk.
Chlamydia prevalence and social variation at age 17 were further examined in
the Avon Longitudinal Study of Parents and Children birth-cohort. After missing
data analysis, chlamydia prevalence was 1.4% (0.8, 2.0); 1.7% (0.8,2.6) in women;
1.0% (0 .3, 1.7) in men. Infection was strongly associated with several measures of
social disadvantage.
Using grounded theory approaches, in-depth and key informant interviews and
non-participant observation in further education colleges, the formative study
revealed that a peer-screening intervention could build on existing social
phenomena such as frequent and open conversations about sexual health,
sharing information and experiences, moral and emotional support and humour.
The majority of interview participants indicated that they would be willing to
participate in the intervention. The intervention may promote uptake of
screening through four mechanisms: 1. acknowledging personal relevance of
screening; 2. increasing perceived benefits; 3. reducing perceived costs; and 4.
providing opportunities for spontaneous testing. The acceptability and
effectiveness of the intervention may be enhanced by offering a choice of self-test
kits or cards, wider promotion of pro-screening norms, and attractive and
humorous promotional materials. No evidence was found to suggest that the
intervention would be less acceptable amongst the socially disadvantaged.
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