How social representations of sexually transmitted infections influence experiences of genito-urinary symptoms and care-seeking in Britain: mixed methods study protocol

The effect of sexuality education based on the information, motivation, and behavioral skills model on improving the teachers' professional competence

Introduction

Professional competence is the basic need of teachers in effective sexuality education. Therefore, the aim of this study was to evaluate the impact of school-based sexuality education (SBSE) on teachers' professional competence (TPC), using the information, motivation, and behavioral skills (IMB) model, in boys' schools.

Methods

A randomized controlled field trial was conducted on 60 teachers who taught adolescents aged 11-19 years and were selected from 12 public boys' schools in Sari, northern Iran. Two groups (intervention and control) were assigned using a multi-stage stratified random sampling method. Researchers utilized a self-reported socio-demographic questionnaire and an IMB model-based questionnaire to assess the effects of the educational program. Four groups of 6-8 people underwent six 2-h training sessions based on an IBM model. Teachers were assessed before, immediately, and six weeks after the intervention to evaluate the outcome variables. The data were analyzed using the software SPSS-V19 and Chi-square test, Independent t-test, One-way ANOVA, and Repeated Measure ANOVA.

Results

There were no significant differences between intervention and control groups at the baseline in socio-demographic characteristics and TPC (p > 0.05). The mean scores of TPC in sexuality education in every three dimensions of knowledge (P = 0.001), skill (P = 0.002), and attitude (P = 0.007) were significantly higher in the intervention group than in the control group.

Conclusions

The results of this study show that by using the SBSE program based on the IMB model, the TPC for teaching sexual issues can be improved.

STI testing, diagnoses and online chlamydia self-sampling among young people during the first year of the COVID-19 pandemic in England

PURPOSE

COVID-19 control measures reduced face-to-face appointments at sexual health services (SHSs). Remote access to SHSs through online self-sampling was increased. This analysis assesses how these changes affected service use and STI testing among 15-24 year olds ('young people') in England.

METHODS

Data on all chlamydia, gonorrhoea and syphilis tests from 2019-2020, among English-resident young people were obtained from national STI surveillance datasets. We calculated proportional differences in tests and diagnoses for each STI, by demographic characteristics, including socioeconomic deprivation, between 2019-2020. Binary logistic regression was used to determine crude and adjusted odds ratios (OR) between demographic characteristics and being tested for chlamydia by an online service.

RESULTS

Compared to 2019, there were declines in testing (chlamydia-30%; gonorrhoea-26%; syphilis-36%) and diagnoses (chlamydia-31%; gonorrhoea-25%; syphilis-23%) among young people in 2020. Reductions were greater amongst 15-19 year-olds vs. 20-24 year-olds. Amongst people tested for chlamydia, those living in the least deprived areas were more likely to be tested using an online self-sampling kit (males; OR = 1.24 [1.22-1.26], females; OR = 1.28 [1.27-1.30]).

CONCLUSION

The first year of the COVID-19 pandemic in England saw declines in STI testing and diagnoses in young people and disparities in the use of online chlamydia self-sampling which risk widening existing health inequalities.

Help-seeking for genitourinary symptoms: a mixed methods study from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

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.

PRIME (Positive Transitions Through the Menopause) Study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England

INTRODUCTION

Advances in antiretroviral therapy have transformed HIV into a long-term condition with near-normal life expectancy for those in whom viral replication is well controlled on treatment. This means that age-related events, including menopause, is of increasing importance in the care of people living with HIV. The PRIME (Positive Transitions Through the Menopause) Study aims to explore the impact of the menopause on the health and well-being of women living with HIV (WLHIV).

METHODS AND ANALYSIS

The PRIME Study is a multicentre, mixed-methods observational study deploying a multiphase sequential design with explanatory and exploratory phases. Phase 1 comprised three focus group discussions with WLHIV. In phase 2 we aimed to administer questionnaires comprising detailed assessment of menopausal status and symptoms to 1500 WLHIV aged 45-60 attending HIV clinics in England. Phase 3 comprised semistructured interviews with a subsample of phase 2 participants. Ongoing quantitative follow-up of 100 participants is planned between October 2018 and September 2019. Qualitative and quantitative data will be kept analytically distinct and analysed using appropriate methods. We will integrate quantitative and qualitative findings using coding matrices.

ETHICS AND DISSEMINATION

The PRIME Study has ethical approval from the South East Coast-Surrey Research Ethics Committee on behalf of all National Health Service (NHS) sites, and approval from University College London Research Ethics Committee for qualitative work conducted in non-NHS sites. In conjunction with the study Expert Advisory Group (which includes WLHIV), we have drafted a dissemination strategy that takes into account a wide range of stakeholders, including patients, policy makers and healthcare providers. This includes at least five empirical research papers to be submitted to peer-reviewed journals, as well as an accessible report aimed primarily at a non-technical audience (published in May 2018 and launched at a live-streamed event). Both quantitative and qualitative data are held by the PRIME Study team and are available by request.

Awareness of and attitudes to sexually transmissible infections among gay men and other men who have sex with men in England: a qualitative study

Background Rates of sexually transmissible infections (STIs) have increased over recent years among gay men and other men who have sex with men (MSM) in England and Wales. HIV diagnoses remain high in this group and men with diagnosed HIV are disproportionally affected by STIs. MSM are therefore a priority for health promotion efforts to reduce STIs. Understanding awareness of and attitudes towards STIs is essential in developing health promotion interventions to reduce prevalence. Methods: Eight focus group discussions (FGDs) with a total of 61 MSM in four English cities included a ranking exercise to gauge how ‘scary’ participants thought 11 STIs are. The exercise sought insights into participants’ awareness of, knowledge about and attitudes towards STIs and blood-borne viruses (BBVs). FGDs were audio-recorded, transcribed and data analysed thematically. Results: All groups ranked HIV and Hepatitis C virus (HCV) as the scariest infections, and the majority ranked syphilis and herpes as highly scary. Scabies was ranked as the least scary by most groups. Rankings were dependent on how well informed participants felt about an infection, its transmission mechanisms, health affect and the availability of vaccines and treatment. Personal experience or that of friends influenced perceptions of particular infections, as did their prevalence, treatment options, visibility of symptoms and whether an STI could be cleared from the body. Conclusions: The study findings suggest that, although some MSM are well informed, there is widespread lack of knowledge about the prevalence, modes of transmission, health implications and treatment regimens of particular STIs.

Identification Reduces Stigma of Mental Ill-Health: A Community-Based Study

The stigma surrounding mental ill-health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill-health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill-health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill-health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill-health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well-being.

Understanding sexual healthcare seeking behaviour: why a broader research perspective is needed

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.