An online study combining the constructs from the theory of planned behaviour and protection motivation theory in predicting intention to test for chlamydia in two testing contexts

Contact investigations for antibiotic-resistant bacteria: a mixed-methods study of patients' comprehension of and compliance with self-sampling requests post-discharge

BACKGROUND

Contact investigation is an important tool to identify unrecognized patients who are colonized with antibiotic-resistant bacteria. Many Dutch hospitals include already discharged contact patients by sending them a self-sampling request at home, incl. an information letter and sampling materials. Each hospital composes these information letters on their own initiative, however, whether discharged patients comprehend and comply with these requests remains unclear. Therefore, the aim was to provide insight into patients' comprehension of and self-reported compliance with self-sampling requests post-discharge.

METHODS

This mixed-methods study was performed in eight Dutch hospitals. First, the Common European Framework of Reference (CEFR) language level of self-sampling request letters was established. Second, a questionnaire about patients' comprehension of the letter, self-reported compliance, and reasons for compliance or non-compliance were sent to patients that received such a request in 2018/2019. Finally, a random selection of questionnaire respondents was interviewed between January and March 2020 to gain additional insights.

RESULTS

CEFR levels of 15 letters were established. Four letters were assigned level B1, four letters B1-B2, and seven letters B2. The majority of patients reported good comprehension of the letter they had received. Conversely, some respondents indicated that information about the bacterium (18.4%), the way in which results would be communicated (18.1%), and the self-sampling instructions (9.7%) were (partially) unclear. Furthermore, self-reported compliance was high (88.8%). Reasons to comply were personal health (84.3%), the health of others (71.9%), and general patient safety (96.1%). Compliant patients appeared to have a need for confirmation, wanted to protect family and/or friends, and felt they were providing the hospital the ability to control the transmission of antibiotic-resistant bacteria. Although a limited number of non-compliant patients responded to the questionnaire, it seemed that more patients did not comply with self-sampling requests when they received a letter in a higher CEFR-level (B2) compared to a lower CEFR-level (< B2) (9.8% vs. 2.5%, P = 0.049).

CONCLUSIONS

This study showed an overall good comprehension of and high self-reported compliance with self-sampling requests post-discharge. Providing balanced information in self-sampling request letters has the potential to reduce patient's ambiguity and concerns, and can cause increased compliance with self-sampling requests.

Predictors of protective behaviours during the Italian Covid-19 pandemic: an application of protection motivation theory

OBJECTIVE

The study investigated whether Protection Motivation Theory (PMT) constructs predicted recommended protective behaviours soon after the Italian lockdown and 1-year later.

DESIGN

A three-wave longitudinal design was used. Three-hundred-fifty-two adults completed online questionnaires with PMT and intention measures assessed during the Italian lockdown (T1), and behaviour measures assessed after 1-month (T2) and 1-year (T3).

OUTCOME MEASURES

Intentions to adopt behaviours (T1) and behaviour adherence at T2 and T3.

RESULTS

From T2 to T3, participants reported less adoption of distance behaviours, but higher face masks use. In SEM models, self-efficacy and perceived severity were the strongest predictors of intentions to engage in protective behaviours. Intentions (β = 0.490, p < 0.001) and fear arousal (β = 0.134 p = 0.035) predicted protective behaviours at T2. Intentions (β = 0.302, p = 0.001) and perceived severity (β = 0.431, p < 0.001) predicted protective behaviours at T3.

CONCLUSION

To increase intentions, intervention should highlight the severity of getting infected and target perceptions of one's ability to perform the protective behaviours. In addition, interventions should consider that at the beginning of the pandemic, fear predicted the adoption of preventive behaviours while perceived severity of the disease had a greater impact over time.

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

Objectives

Online services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services.

Methods

We conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users.

Results

6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British.

Conclusion

Nearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups.

An instrument based on protection motivation theory to predict Chinese adolescents' intention to engage in protective behaviors against schistosomiasis

Background

Further advancement in schistosomiasis prevention requires new tools to assess protective motivation, and promote innovative intervention program. This study aimed to develop and evaluate an instrument developed based on the Protection Motivation Theory (PMT) to predict protective behavior intention against schistosomiasis among adolescents in China.

Methods

We developed the Schistosomiasis PMT Scale based on two appraisal pathways of protective motivation- threat appraisal pathway and coping appraisal pathway. Data from a large sample of middle school students (n = 2238, 51 % male, mean age 13.13 ± 1.10) recruited in Hubei, China was used to evaluated the validity and reliability of the scale.

Results

The final scale contains 18 items with seven sub-constructs. Cronbach's Alpha coefficients for the entire instrument was 0.76, and for the seven sub-constructs of severity, vulnerability, intrinsic reward, extrinsic reward, response efficacy, self-efficacy and response cost was 0.56, 0.82, 0.75, 0.80, 0.90, 0.72 and 0.70, respectively. The construct validity analysis revealed that the one level 7 sub-constructs model fitted data well (GFI = 0.98, CFI = 0.98, RMSEA = 0.03, Chi-sq/df = 3.90, p < 0.001). Predictive validity showed that both the PMT instrument score and the 7 sub-construct scores were significantly correlated with the intention engaged in protective behavior against schistosomiasis (p < 0.05).

Conclusions

This study provides a reliable and valid tool to measure protective motivation in schistosomiasis prevention control. Further studies are needed to develop more effective intervention programs for schistosomiasis prevention.

Perceptions of Self-Testing for Chlamydia: Understanding and Predicting Self-Test Use

BACKGROUND

Self-testing technology allows people to test themselves for chlamydia without professional support. This may result in reassurance and wider access to chlamydia testing, but anxiety could occur on receipt of positive results. This study aimed to identify factors important in understanding self-testing for chlamydia outside formal screening contexts, to explore the potential impacts of self-testing on individuals, and to identify theoretical constructs to form a Framework for future research and intervention development.

METHODS

Eighteen university students participated in semi-structured interviews; eleven had self-tested for chlamydia. Data were analysed thematically usingaFrameworkapproach.

RESULTS

Perceivedbenefitsofself-testingincludeditsbeingconvenient, anonymousandnotrequiringphysicalexamination. Therewasconcernabouttestaccuracyandsome participants lacked confidence in using vulvo-vaginal swabs. While some participants expressed concern about the absence of professional support, all said they would seek help on receiving a positive result. Factors identified in Protection Motivation Theory and the Theory of Planned Behaviour, such as response efficacy and self-efficacy, were found to be highly salient to participants in thinking about self-testing.

CONCLUSIONS

These exploratory findings suggest that self-testing independentlyofformalhealthcaresystemsmaynomorenegativelyimpactpeoplethanbeingtested by health care professionals. Participants' perceptions about self-testing behaviour were consistent with psychological theories. Findings suggest that interventions which increase confidence in using self-tests and that provide reassurance of test accuracy may increase self-test intentions.