Young Women's Perspective of the Pros and Cons to Seeking Screening for Chlamydia and Gonorrhea: an Exploratory Study
Kirk L. Von Sternberg, PhD, University of Texas at Austin, Mariam R. Chacko, MD, Baylor College of Medicine, Mary M. Velasquez, PhD, University of Texas at Austin, Constance M. Wiemann, PhD, Baylor College of Medicine, Peggy Smith, PhD, Baylor College of Medicine, and Ralph J. DiClemente, PhD, Emory University.
Purpose: Sexually transmitted infections (STI) such as chlamydia (CT) and gonorrhea (NGC) cervical infections in young women are a serious public health problem. Early detection and treatment of asymptomatic and symptomatic infections can reduce the duration of infection, the risk of transmission to other partners and the incidence of pelvic inflammatory disease, tubal damage and infertility. To promote client-initiated STI screening, it is important to increase our understanding of young women's STI health-seeking behaviors. Decisional balance is a process of cognitively appraising the “good” aspects or pros, and the “less good” aspects or cons of a behavior and the reasons to change and not to change that behavior. Decisional Balance, an integral part of the Transtheoretical Model (TTM), has been shown to be an important construct in understanding the process of intentional change of problem behaviors and adoption of healthy behaviors. The purpose of this study is to conduct an analysis of young women's pros and cons (decisional balance) to seeking screening for chlamydia (CT) and gonorrhea (NGC) infection. Methods: This study is part of a larger trial in which motivational interviewing is used to facilitate client-initiated STI screening in young women at risk for CT and NGC. Young women (n=376) attending an urban community reproductive health clinic, were randomly assigned at baseline to one of two groups: an intervention plus standard-of-care group or the standard-of-care only group. Statements provided by 192 young women in the intervention plus standard-of-care group (66% African American, mean age 18.9 years) during an exercise to identify pros and cons to CT and NGC screening were analyzed. Primary thematic categories were developed through a two-step coding process based on Grounded Theory methodology, (1) open and axial coding, and (2) assigning each response into one of the primary thematic categories by consensus of an investigator panel. The frequency of unduplicated pros and cons responses for each category and the frequency of participants endorsing each category were calculated. Results: 569 pros and 295 cons representing unduplicated primary responses were identified. Ten thematic categories in relationship to seeking screening were defined: being healthy, awareness of knowing the body, systemic factors around the clinic visit and testing procedures, benefits and aversions around treatment, partner relationship issues, confidentiality, prevention of long term effects / protection of the body, concern for others, fear of results / aversion to testing, and logistical barriers. The top three pros were: awareness of knowing the body (87%), being healthy (72%) and treatment issues (56%); and the top three cons were: logistical barriers (time/transportation; 56%), fear/aversion to testing (47%), and systemic issues (14%). Implications: This study provides clinicians with valuable information on designing targeted strategies and potential ways to address young women's perceived pros and cons to enhance seeking of CT and NGC screening. Clinical sessions and clinic-based educational strategies can emphasize the positive aspects of seeking screening. They can also dispel fears about medications and blood draws (not necessary at every clinic visit) and provide ways to think about and address a positive test result.