Chlamydia screening and sexual health: Research with young people
Direction for Communications Development
The research demonstrated very good and consistent awareness of both Chlamydia and the availability of testing amongst this sample: indeed, in most cases it was perceived as the STI that was most likely to pose a personal threat to respondents. However, while this demonstrates that Chlamydia is definitely ‘on the radar’ of the target audience, it was low consciousness and low personal interest for many, with day to day concerns such as money and, in terms of sexual health, considerations of accidental pregnancy being much higher on their agenda.
Inertia and complacency within the target audience came partly from lack of specific knowledge about Chlamydia as an infection. While they were aware that it exists and is a problem, there was little detailed knowledge about how it spreads, how it manifests itself (invisibility) and also the potential for damage.
However, currently knowing ‘a little’ about Chlamydia also seemed to be directly contributing to inertia: awareness per se leading many to feel in control of their personal risk.
The critical task for DH and NCSP is therefore to change the detail of what the target currently know about Chlamydia (as well as keep awareness high). Fortunately, a range of evidence and detail about Chlamydia was considered compelling, credible and relevant to the target audience. Indeed, this research indicates that there is great potential for changing the detail of what the audience do know, as well as helping shift them from their current inertia and complacency regarding their own levels of risk towards action.
In order to cut through existing defences, however, some shock value is required. Most testers within the research sample had only been shocked into action themselves by receiving ‘news’ (either from partners or via NCSP) or experiencing symptoms themselves.
The nature of shock, however, is really important for credibility and impact. The ‘problem’ of Chlamydia needs to feel insidious, and that it is not possible for them to control the risk without taking steps – either in the form of screening or using condoms. This perceived threat needs to be supported by evidence of the real damage that Chlamydia can do.
When concern about Chlamydia is raised in response to this information, the audience then shifts to a position of wanting or needing a strategy for managing the risk of Chlamydia: controlling the risk is seen as an essential and compelling thing to do.
Focusing strongly on the ‘medical condition’ (the nature of Chlamydia, the way is spreads and so on) versus ‘target behaviour’ also contributes to increasing acceptance of personal risk and reducing perceptions of stigma – as the target become less ‘to blame’ than the infection itself.
Assuming the desired service considerations are in place, testing offers a very valuable solution for the audience. It raises fewer emotional barriers to uptake than condoms and is therefore embraced as a preferable alternative to condoms by the target audience. Clearly, to prevent screening becoming ‘emergency Chlamydia protection’ rather than a preventative measure, messaging/communications around the specific role of condoms will also be important.
Respondents tended to assume the need for condoms is negated by testing and being proved clear. With explanation, however, the target audience could understand that they will still be at risk through certain circumstances and sexual behaviours. This is not sufficiently interesting in itself to warrant action, but if it is understood that repeat infection with Chlamydia is increasingly problematic, then the argument for using condoms becomes more compelling (although the existing range of barriers attached to condom use are likely to persist to a degree).
Given the explanation for where condom use fits is relatively complicated, however, this strand of communication appears to be particularly important for face to face communication at the point of service delivery from NCSP. Messaging through other channels will also help, but care should obviously be taken to avoid information overload and dominance of a condom message – since the implicit negativity attached to condoms is likely to be distracting and risks diluting take out around screening.
Establishing a norm of testing will be helpful in overcoming or setting aside strong barriers that arise from stigma. As such, there is also a role for a primary communications strand around ‘norm’ which supports the notion that all young people ‘should’ be testing for Chlamydia.
Needs for positioning this ‘norm’ appear specific, as subtle differences in what ‘norm’ is attached to can have a critical impact on individuals’ personal perceptions of need as a result:
- If it is perceived that everyone else is testing currently, this can prompt the notion that ‘I feel safe and protected’ and reduces the need for testing oneself.
- If it is perceived that everyone needs to test, then not only do ‘I need to’ take the test to protect myself, but ‘I also run a risk of being stigmatised as an irresponsible minority’ by not conforming.
Based on reactions to the stimulus tested, there is some evidence that perceptions of ‘norm’ and personal need can be bound up in the same communications approach.
Findings indicate that there are two aspects of service provision which are critical to deliver, as well as communicate at the first contact with the target audience:
- Confidentiality (across all service aspects)
- Simplicity and ease of the test (ideally the option of ‘Pee in Pot’ testing in all areas)
The need for confidentiality runs through from the initial contact with the target audience, through to results, medical records and partner notification. The latter is a particularly important benefit for new screeners who are held back by concerns around how to manage outcomes. In order to avoid inadvertently encouraging stigma, however, it appears important that these aspects are communicated as aspects of support/options if required, rather than overarching benefits.
Simplicity and ease of the test are also important to communicate due to spontaneous perceptions which are currently to the contrary and act as a major barrier.
The target appears to have very idiosyncratic preferences with regard to the location and accessibility of testing, although this seems to correlate to an extent with gender: females in this sample tended to prefer face to face contact and an ongoing relationship, whereas males preferred distance and transactional contact only.
The ideal testing service within any given area would therefore offer options of face to face alongside distance options with anonymous post backs to suit individual preferences.
The concepts of ‘opportunistic’ and ‘mandatory’ approaches to testing where respondents are not required to self-select (and therefore make a personal statement about need and/or sexual behaviour) were well received and appear likely to assist directly to perceptions of a growing norm around the need for all young people to test and keep testing.
The benefits attached to face to face services (for those who use them already and some who anticipate that they would prefer this option) indicate a more developed role could be played by service providers in delivering information and skills to this segment of the target audience to assist with sexual health management.
In terms of results turnaround, two weeks appears to be pushing the boundaries of audience tolerance and may be inhibitive. Therefore any potential to shorten the process would be well received. Given that length of waiting acts as a barrier, it will be important to avoid including this in communications as this negatively mitigates the notion of ease.
Again, offering options for receiving results would be ideal to allow for individual preferences (which varied), but text and email appeared the most commonly preferred routes.
Early Indications on Branding Requirements
Common (national) branding of some sort is likely to help build the sense of importance and need for a national shift in behaviour with respect to Chlamydia and Chlamydia testing.
Additionally national branding can potentially assist with expectations around the test being ‘easy’ (easy to access and experience) as well as being ‘free’.
The research indicated that communications about Chlamydia testing do not sit comfortably under the Condom Essential Wear brand, largely through the implicit focus on condom usage. Condoms as ‘essential wear’ do fit within the overall story (once it is fully understood by the target audience), but the learning curve is too long and steep to provide a good fit, connection and understanding in the first instance.
The overall objective of this strand of the research was to inform the development of an appropriate and compelling marketing campaign that supports the NCSP and drives the target audience towards its use.
The Department of Health’s (DH) Adult Sexual Health Marketing Strategy for 2008/9 reflected a shift of emphasis from previous years to focus specifically on increasing the volume of screening for Chlamydia. Growing evidence suggests that targeting at-risk populations and driving towards screening will significantly reduce the occurrence of Chlamydia over time. There is also a strong economic case for this approach.
The strategy is based primarily on the efforts of the National Chlamydia Screening Programme (NCSP) with a target to screen 17% of 16-24 year olds by March 2009. The overall aim of the strategy is to get to a point in future years where 40%-50% of the demographic are screening every year and with every new partner in order to reduce the prevalence.
For screening to be an effective strategy however, it is imperative that the volume of those identified as “at-risk” increases significantly and that a culture of testing is established. Marketing and communications activity is therefore being developed to support NCSP activity and drive the target audience towards the programme.
To assist in developing a successful marketing and communications campaign, research was required to inform overall direction of marketing and understand most compelling messages for the target audience to take up screening.
Research was undertaken with both stakeholders and young people. This summary focuses on findings gathered from the young people audience. Findings from the stakeholder audience are reported in a separate summary.
This research indicates that there is great potential for changing the detail of what the young people do know about Chlamydia by harness their current high levels of awareness as well as helping shift them from their current inertia and complacency regarding their own levels of risk towards action.
Ethnicity represented location resulting in 5 female and 7 males from Afro-Caribbean background across the sample
40 paired depth interviews (1.5 hours with 2 respondents each - 20x male, 20x female) comprising:
- a mix of who have had one night stands, those in a fledgling relationship, and those who have / have had multiple or concurrent partners
- a mix of those who have never screened, those who have screened repeatedly and those who have screened once only
- a maximum quota on those who had attended/used sexual health services and a minimum on those who had not.
40 paired depths (n=80)
Between 22nd September and 9th October 2008