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Non-participation in chlamydia screening in The Netherlands: determinants associated with young people's intention to participate in chlamydia screening.

ten Hoor GA, Ruiter RA, van Bergen JE, Hoebe CJ, Houben K, Kok G - BMC Public Health (2013)

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Work & Social Psychology, Maastricht University, P,O, Box 616, 6200MD Maastricht, The Netherlands. Gill.tenHoor@MaastrichtUniversity.nl.

ABSTRACT

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 (R2 = .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.

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Flowchart illustrating the procedure of the study and the number of participants.
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Figure 2: Flowchart illustrating the procedure of the study and the number of participants.

Mentions: After giving informed consent by clicking on the appropriate button (see also Additional file 1 for the original and translated informed consent), participants were randomized. Subsequently, the participants in the letter-groups read the invitation letter, after which the implicit associations were measured; the no-letter group started after randomization immediately with the implicit association measures. Then, all participants received a self-report questionnaire in which reasoned reactions, including intentions, and past behaviors were measured. Reasoned reactions were measured last because their measurement may influence implicit associations. Finally, people in the two letter-groups received another short questionnaire to evaluate the letter they read, after which all participants were debriefed (see Figure 2). At the beginning of the study, participants were informed about the procedures but not about the content of the study, as associations and answers might be influenced. This study was approved by the Research Ethics Board of the Faculty of Psychology and Neuroscience, Maastricht University.


Non-participation in chlamydia screening in The Netherlands: determinants associated with young people's intention to participate in chlamydia screening.

ten Hoor GA, Ruiter RA, van Bergen JE, Hoebe CJ, Houben K, Kok G - BMC Public Health (2013)

Flowchart illustrating the procedure of the study and the number of participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222760&req=5

Figure 2: Flowchart illustrating the procedure of the study and the number of participants.
Mentions: After giving informed consent by clicking on the appropriate button (see also Additional file 1 for the original and translated informed consent), participants were randomized. Subsequently, the participants in the letter-groups read the invitation letter, after which the implicit associations were measured; the no-letter group started after randomization immediately with the implicit association measures. Then, all participants received a self-report questionnaire in which reasoned reactions, including intentions, and past behaviors were measured. Reasoned reactions were measured last because their measurement may influence implicit associations. Finally, people in the two letter-groups received another short questionnaire to evaluate the letter they read, after which all participants were debriefed (see Figure 2). At the beginning of the study, participants were informed about the procedures but not about the content of the study, as associations and answers might be influenced. This study was approved by the Research Ethics Board of the Faculty of Psychology and Neuroscience, Maastricht University.

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Work & Social Psychology, Maastricht University, P,O, Box 616, 6200MD Maastricht, The Netherlands. Gill.tenHoor@MaastrichtUniversity.nl.

ABSTRACT

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 (R2 = .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.

Show MeSH
Related in: MedlinePlus