TY - JOUR
T1 - Non-participation in chlamydia screening in the Netherlands
T2 - determinants associated with young people’s intention to participate in chlamydia screening
AU - ten Hoor, G.A.
AU - Ruiter, R.A.C.
AU - van Bergen, J.E.A.M.
AU - Hoebe, C.J.P.A.
AU - Houben, K.
AU - Kok, G.
PY - 2013/11/23
Y1 - 2013/11/23
N2 - Background: In the Netherlands, a national chlamydia screening program started in 2008, but the participation was low and the screening was not cost-effective. This study aimed to explore unconscious and conscious associations with chlamydia screening (16-29 year-olds). In addition, we examined whether information presented in chlamydia screening invitation letters had an effect on the evaluation of these determinants compared to a no-letter group.Methods: An Internet survey was conducted that included self-report measures of attitude, susceptibility, severity, unrealistic optimism, subjective, moral, and descriptive norm, perceived behavioral control, outcome expectations, barriers, intention, and a response time measure to assess unconscious associations of chlamydia screening with annoyance, threat and reassurance.Results: On the unconscious level, participants (N = 713) who received no information letter associated testing for chlamydia with annoyance and threat, but also with reassurance (all p's <.001). On the self-report measures, participants showed a low intention towards chlamydia screening (M = 1.42, range 1-5). Subjective norm, moral norm, perceived susceptibility and attitude were the most important predictors of the intention to screen (R-2 = .56). Participants who rated their susceptibility as high also reported more risky behaviors (p <.001). In the groups that received a letter (N = 735), a weaker unconscious association of chlamydia screening with annoyance was found compared with the no-letter group (p <.001), but no differences were found in reassurance or threat. Furthermore, the letters caused a higher intention (p <.001), but intention remained low (M = 1.74). On a conscious level, giving information caused a more positive attitude, higher susceptibility, a higher subjective and moral norm, and more positive outcome expectations (all p's <.001).Conclusion: Subjective norm, moral norm, susceptibility, and attitude towards chlamydia might be crucial targets to increase chlamydia screening behavior among sexually active young people. This study shows that informational invitation letters increase the intention and the intention-predicting variables. More evidence is needed on whether screening behavior can be increased by the use of an alternative information letter adapted to the specific unconscious and conscious determinants revealed in this study, or that we need other, more interactive behavior change methods.
AB - Background: In the Netherlands, a national chlamydia screening program started in 2008, but the participation was low and the screening was not cost-effective. This study aimed to explore unconscious and conscious associations with chlamydia screening (16-29 year-olds). In addition, we examined whether information presented in chlamydia screening invitation letters had an effect on the evaluation of these determinants compared to a no-letter group.Methods: An Internet survey was conducted that included self-report measures of attitude, susceptibility, severity, unrealistic optimism, subjective, moral, and descriptive norm, perceived behavioral control, outcome expectations, barriers, intention, and a response time measure to assess unconscious associations of chlamydia screening with annoyance, threat and reassurance.Results: On the unconscious level, participants (N = 713) who received no information letter associated testing for chlamydia with annoyance and threat, but also with reassurance (all p's <.001). On the self-report measures, participants showed a low intention towards chlamydia screening (M = 1.42, range 1-5). Subjective norm, moral norm, perceived susceptibility and attitude were the most important predictors of the intention to screen (R-2 = .56). Participants who rated their susceptibility as high also reported more risky behaviors (p <.001). In the groups that received a letter (N = 735), a weaker unconscious association of chlamydia screening with annoyance was found compared with the no-letter group (p <.001), but no differences were found in reassurance or threat. Furthermore, the letters caused a higher intention (p <.001), but intention remained low (M = 1.74). On a conscious level, giving information caused a more positive attitude, higher susceptibility, a higher subjective and moral norm, and more positive outcome expectations (all p's <.001).Conclusion: Subjective norm, moral norm, susceptibility, and attitude towards chlamydia might be crucial targets to increase chlamydia screening behavior among sexually active young people. This study shows that informational invitation letters increase the intention and the intention-predicting variables. More evidence is needed on whether screening behavior can be increased by the use of an alternative information letter adapted to the specific unconscious and conscious determinants revealed in this study, or that we need other, more interactive behavior change methods.
KW - Chlamydia screening
KW - Participation
KW - Non-response
KW - Determinants
KW - Implicit associations
KW - HIGH-RISK
KW - TRACHOMATIS
KW - INFECTION
KW - COGNITION
U2 - 10.1186/1471-2458-13-1091
DO - 10.1186/1471-2458-13-1091
M3 - Article
C2 - 24266906
SN - 1471-2458
VL - 13
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 1091
ER -