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RESEARCH ARTICLE

Identifying and understanding barriers to sexually transmissible infection testing among young people

Richard Oliver de Visser A C and Nancy O’Neill B
+ Author Affiliations
- Author Affiliations

A School of Psychology, University of Sussex, Falmer BN1 9QH, United Kingdom.

B Brighton & Sussex Medical School, Falmer BN1 9PX, United Kingdom.

C Corresponding author. Email: rd48@sussex.ac.uk

Sexual Health 10(6) 553-558 https://doi.org/10.1071/SH13034
Submitted: 15 March 2013  Accepted: 1 October 2013   Published: 28 October 2013

Abstract

Background: To counter the disproportionate impact of sexually transmissible infections (STIs) among young people and encourage higher levels of STI testing, it is necessary to identify the factors that influence STI testing. Methods: A mixed-methods study incorporating a cross-sectional quantitative survey and qualitative analysis of individual interviews was conducted in England. Some 275 university students aged 17–25 years completed an online questionnaire. Interviews were conducted with a purposively selected sample of eight men and women. Results: Multivariate analysis of quantitative data revealed that injunctive norms (i.e. a desire to comply with others’ wishes for testing), descriptive norms (i.e. perceptions of others’ behaviour) and shame related to STIs predicted past testing behaviour. Intention to undergo testing was predicted by greater perceived susceptibility, past testing, stronger injunctive norms and greater willingness to disclose sexual histories. Qualitative analysis of interview data confirmed the importance of perceived susceptibility, normative beliefs, stigma and shame, and perceived ease of testing. Conclusions: To increase STI testing among young people, there is a need to promote pro-testing norms, address low perceived susceptibility and make testing easier.

Additional keywords: attitudes, beliefs, intentions, norms, stigma, theory of planned behaviour.


References

[1]  Health Protection Agency. Sexually transmitted infections in England, 2011. Health Protection Report 2012; 6

[2]  Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991; 50 179–211.
The theory of planned behavior.Crossref | GoogleScholarGoogle Scholar |

[3]  McEachan RRC, Conner MT, Taylor NJ, Lawton RJ. Prospective prediction of health-related behaviors with the Theory of Planned Behavior: a meta-analysis. Health Psychol Rev 2011; 5 97–144.
Prospective prediction of health-related behaviors with the Theory of Planned Behavior: a meta-analysis.Crossref | GoogleScholarGoogle Scholar |

[4]  Bennett P, Bozionelos G. The theory of planned behaviour as predictor of condom use: a narrative review. Psychol Health Med 2000; 5 307–26.
The theory of planned behaviour as predictor of condom use: a narrative review.Crossref | GoogleScholarGoogle Scholar |

[5]  Bish A, Sutton S, Golombok S. Predicting uptake of a routine cervical smear test: a comparison of the health belief model and the theory of planned behaviour. Psychol Health 2000; 15 35–50.
Predicting uptake of a routine cervical smear test: a comparison of the health belief model and the theory of planned behaviour.Crossref | GoogleScholarGoogle Scholar |

[6]  Godin G, Kok G. The theory of planned behavior: a review of its applications in health-related behaviors. Am J Health Promot 1996; 11 87–98.
The theory of planned behavior: a review of its applications in health-related behaviors.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s7jt1OltA%3D%3D&md5=8efb742959c05643e0adc2340d7f74fcCAS | 10163601PubMed |

[7]  Rivis A, Sheeran P. Descriptive norms as an additional predictor in the theory of planned behaviour: a meta-analysis. Curr Psychol 2003; 22 218–33.
Descriptive norms as an additional predictor in the theory of planned behaviour: a meta-analysis.Crossref | GoogleScholarGoogle Scholar |

[8]  Becker MH. The Health Belief Model and personal health behaviour. Health Educ Monogr 1974; 2 324–508.

[9]  de Visser RO, Waites L, Parikh C, Lawrie AB. The importance of social norms for uptake of catch-up human papillomavirus vaccination in young women. Sex Health 2008; 5 331–8.

[10]  Cunningham SD, Kerrigan DL, Jennings JM, Ellen JM. Relationships between perceived STD-related stigma, STD-related shame and STD screening among a household sample of adolescents. Perspect Sex Reprod Health 2009; 41 225–30.
Relationships between perceived STD-related stigma, STD-related shame and STD screening among a household sample of adolescents.Crossref | GoogleScholarGoogle Scholar | 20444177PubMed |

[11]  Cunningham SD, Tschann J, Gurvey JE, Fortenberry JD, Ellen JM. Attitudes about sexual disclosure and perceptions of stigma and shame. Sex Transm Infect 2002; 78 334–8.
Attitudes about sexual disclosure and perceptions of stigma and shame.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38nkvVCksw%3D%3D&md5=80546246d37a3c67d4e16c6f8e7228fbCAS | 12407233PubMed |

[12]  Consedine NS, Krivoshekova YS, Harris CR. Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment. Br J Health Psychol 2007; 12 439–62.
Bodily embarrassment and judgment concern as separable factors in the measurement of medical embarrassment.Crossref | GoogleScholarGoogle Scholar | 17640455PubMed |

[13]  Rissel CE, Richters J, Grulich AE, de Visser RO, Smith AMA. Attitudes towards sex in a representative sample of adults. Aust N Z J Public Health 2003; 27 118–23.
Attitudes towards sex in a representative sample of adults.Crossref | GoogleScholarGoogle Scholar | 14696701PubMed |

[14]  Grulich AE, de Visser RO, Smith AMA, Rissel CE, Richters J. Knowledge about sexually transmitted infections and blood-borne viruses in a representative sample of adults. Aust N Z J Public Health 2003; 27 230–3.
Knowledge about sexually transmitted infections and blood-borne viruses in a representative sample of adults.Crossref | GoogleScholarGoogle Scholar | 14696716PubMed |

[15]  Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis. London: Sage, 2009.

[16]  Fife-Schaw C, Sheeran P, Norman P. Simulating behaviour change interventions based on the theory of planned behaviour. Br J Soc Psychol 2007; 46 43–68.
Simulating behaviour change interventions based on the theory of planned behaviour.Crossref | GoogleScholarGoogle Scholar | 17355718PubMed |

[17]  Fishbein M, Yzer MC. Using theory to design effective health behavior interventions. Commun Theory 2003; 13 164–83.

[18]  Green R, Kerry SR, Reid F, Hay PE, Kerry SM, Aghaizu A, et al Where do sexually active female London students go to access healthcare? Sex Transm Infect 2012; 88 315
Where do sexually active female London students go to access healthcare?Crossref | GoogleScholarGoogle Scholar |

[19]  Saunders JM, Mercer CH, Sutcliffe LJ, Hart GJ, Cassell J, Estcourt CS. Where do young men want to access STI screening? Sex Transm Infect 2012; 88 427–432.
Where do young men want to access STI screening?Crossref | GoogleScholarGoogle Scholar | 22510331PubMed |

[20]  Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement. Adv Exp Soc Psychol 2006; 38 69–119.
Implementation intentions and goal achievement.Crossref | GoogleScholarGoogle Scholar |

[21]  Sheeran P, Orbell S. Using implementation intentions to increase attendance for cervical cancer screening. Health Psychol 2000; 19 283–9.
Using implementation intentions to increase attendance for cervical cancer screening.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FhsFaksA%3D%3D&md5=318c91d78a7bb209d1503a5e8dc106c8CAS | 10868773PubMed |

[22]  Llewellyn C, Pollard A, Miners A, et al Understanding patient choices for attending sexually transmitted infection testing services. Sex Transm Infect 2012; 88 504–509.
Understanding patient choices for attending sexually transmitted infection testing services.Crossref | GoogleScholarGoogle Scholar | 22628665PubMed |

[23]  de Visser RO, Smith AMA, Richters J. Can we generalise to other young people from studies of sexual risk behaviour among university students? Aust N Z J Public Health 2005; 29 436–41.
Can we generalise to other young people from studies of sexual risk behaviour among university students?Crossref | GoogleScholarGoogle Scholar |

[24]  Johnson SA, Simms I, Sheringham J, Bickler G, Bennett CM, Hall R, et al The implementation of Chlamydia screening: a cross-sectional study in the south east of England. Sex Transm Infect 2010; 86 217–21.
The implementation of Chlamydia screening: a cross-sectional study in the south east of England.Crossref | GoogleScholarGoogle Scholar | 20460264PubMed |