How can we approach chlamydia screening with girls & young women? Preliminary findings from CDC focus groups Allison Friedman, MS Division 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 ( ) 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 BarriersBenefits 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 women 3. 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 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)  2 nd 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

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