How can we approach chlamydia screening with girls

& young women? Preliminary findings from CDC

focus groups

Allison Friedman, MSDivision of STD Prevention

Centers for Disease Control & Prevention

Background: Chlamydia burden

Estimated 2.8 million new cases of Chlamydia (CT) in the U.S. each year. [1] Highest rate among 15-to-24 year-old females

CT is treatable w/antibiotics, but usually asymptomatic. Most of those infected do not know or seek testing

CT is a leading cause of pelvic inflammatory disease (PID), which can lead to ectopic pregnancy, chronic pelvic pain & infertility.

Annual CT screening recommended for sexually active women <26 yrs.

Yet only ~40% of eligible young women get screened annually. [2]

[1] Weinstock et al., 2004[2] NCQA.(2009). The State of Health Care Quality 2009.

To address low rates of CT screening, CDC’s Division of STD Prevention is developing a national social marketing campaign to promote CT screening among sexually active young women , ages 15-25yrs.

African American Caucasian Hispanic

Project Background

Project Activities Literature Review (2007)   Exploratory Research (2007-2008)

Phone interviews (n=80) In-person interviews (n=45)

Concept & Message Testing (Nov-Dec 2009) 18 Focus Groups in 4 cities

Summary of Exploratory Research Findings

Very few young women had substantial knowledge of CT.

Most were unaware of: CT’s asymptomatic nature, potential to cause infertility Recommendation for routine CT testing Urine test for CT

Perceived Barriers & Benefits to Screening

Barriers Benefits• Fear (testing, positive results, parents finding out)

• Knowing one’s STD status

• Privacy concerns; peer stigma • Ability to take action if positive

• Access • Confirm negative status (reassurance)

• Lack of symptoms/perceived susceptibility

• Being responsible

• Embarrassment

• Lack of awareness

Exploratory Research Findings (cont’d)

Young women were motivated by info that increased awareness and perceived susceptibility, severity & risk of disease, while offering simple, actionable solutions:

CT is common & often asymptomatic CT can cause infertility A simple test and cure are available for CT

Concept & Message Development

Guided by exploratory research findings & 2 theoretical frameworks Health Belief Model Theory of Planned Behavior

Three main concepts designed to:1. Diminish identified barriers:

Overcome stigma Emphasize ease of testing

2. Empower women3. Emphasize women’s health and infertility, in relation to life

aspirations

Six posters developed to represent these concepts

1. Diminishing Barriers: Overcoming Stigma

1. Diminishing Barriers:Ease of Testing

2. Empowerment

3. Women’s Health & Infertility (in context of broader Life Aspirations)

Concept/Message Testing Focus Groups Methods

18 focus groups conducted in 4 cities. Participant inclusion criteria:

Young women, ages 15-25yrs African American, Caucasian or Hispanic Working & in school English speaking Sexually active or had sought reproductive health services Mix of income/SES

Segmented by age, race/ethnicity, and school/work status (adults)

Groups also explored dissemination preferences Interviews were transcribed & coded using NVivo2.

Participant Demographics

Age15–17 6618–25 56Race/EthnicityAfrican American 40Hispanic 44Caucasian 38

• Total of 122 women participated in focus groups

Key Findings: Concept Preferences

1. Woman you want to be (Infertility) most liked & motivating emotional appeal, values positive message, empowering vibrant colors - attention getting

2. Few people talk about it, lots of people do it (Stigma) 2nd most liked everyone is at risk relatable situation focus on female and male

General vs. Specific Approach

STD vs. CT: CT slightly preferred: novel, relevant STD brand more recognized

Female vs. Male/Female F focus for infertility, but imagery/messaging should

include M Relationships, partner support = well received

If focus is STD testing, important to include both M & F

Key Findings (cont’d) Audiences want:

Relatable people, relationships, contexts, conversations, testimonials

Diversity Alarming statistics (prevalence) w/easy, actionable solutions Direct, upfront messaging & logos

Audiences do not want: Messaging or tone that minimizes seriousness of STDs or

testing Messages suggesting that girls need STD testing & boys do

not

Suggested channels of dissemination

Health care facilities Schools Facebook Twitter Health websites Teen & health magazines TV (MTV, BET, VH1) Outdoor advertising Community events

Information Sources

CDC Planned Parenthood, health clinics Women’s health organizations Community-based organizations NIH

Campaign Website Components

Clinic locator tool Frequently asked questions (FAQs) Personal testimonies, Inspirational quotes Blogs, chat rooms Opportunities to chat w/ or submit a Q to a health

professional Quizzes, polls Public service announcements/videos Hotline for more information

Website should NOT include games

Conclusions & Implications Messages should inspire/empower women and normalize

testing

For young women to pay attention to CT & consider behavior change, messaging must: take CT (STD testing) seriously be thought-provoking, tapping into deeper values

Messaging for STD testing should be ‘equal opportunity’ to avoid stigmatizing a particular group

Design: use of bright colors, diverse models, relatable situations/settings

Traditional & new/interactive media tools needed to reach young audiences, but source should be credible/respected

Contact Me!

Allison Friedmanalf8@cdc.gov

(404) 639-8537