RUClear on how to remove apprehension and treat chlamydia?
There is no denying that screening and treating chlamydia is putting PCTs under pressure to deliver if young people are reluctant to attend clinical services. That said, finding innovative ways to encourage young people to engage with screening services does not have to be difficult. Diane Cordwell, Programme manager of the 'RUClear?' chlamydia screening programme for the Greater Manchester Sexual Health Network, now explains.
Back in 2006, the Greater Manchester health authority set out to be more proactive in taking steps to tackle the rise of chlamydia amongst 15-24 year olds in the region. The RUClear programme was given two aims, and my job as Programme manger was very clear:
- To coordinate screening services and make screening and treatment more accessible
- To encourage young people to access these services
This was an ambitious goal. While increasing awareness in itself presents challenges, encouraging 10% of all 15-24 year olds to get screened and treated was not going to happen overnight. We needed an exciting and innovative plan that was more involved than simply disseminating information passively.
At the start of the programme, we had one fundamental question: how would we engage with a large target audience of young people and get them interested in screening for chlamydia? While it is easy for us to state 'more education', we had to be mindful of resorting to lecturing tactics which health promotion literature tells us simply does not work.
Understanding young people
Our first task was to get to grips with what young people thought about STIs and screening services. We did this by going into colleges and asking their opinion directly; if we wanted to coordinate a unique service, we accepted we needed their help. We discovered that many find traditional screening services intimidating and fear being 'told off' for their sexual lifestyle; although this is probably not reflective of an actual lived experience, this niggling concern could prevent a young person from seeking help.
We also found that some were ambivalent about taking time out to get screened. Others simply assumed if they had contracted an STI they would have symptoms which would prompt them to seek help, not knowing that a chlamydia infection is often asymptomatic.
Removing apprehension, making it easy
We therefore needed to address people's misconceptions as well as explain that getting screened for chlamydia is not difficult; given that a simple urine test can determine the presence of chlamydia, we questioned if it was necessary for a person to pluck up the courage to attend a sexual health clinic at all. After all, many young people trust college teachers, outreach workers, Connexions workers and feel more comfortable asking them for advice.
We considered if we could combine the simplicity of chlamydia screening with these established personal relationships and, if so, would these key-professionals agree to be trained to become screeners and help us achieve the screening and treatment targets?
How would screening work?
We contacted the colleges and local agencies working closely with young people, and provided information on the proposal including how we would support and educate them to be screeners. Training would include how to collect, record and send the samples off to the pathology lab at their local hospital. The response was overwhelmingly positive and these professionals welcomed the opportunity to be part of a proactive solution to tackle the rise of STIs and chlamydia.
Thumbs up to health promotion
Many of the professionals were not only keen to be screeners, they welcomed the opportunity to talk to young people about safer sex and provide information and guidance. To make the most of this opportunity, we felt it was important to provide them with condoms. That way, not only were key-health messages presented, but young people were given what they needed to protect their health.
Our Durex condoms are always well received by the young people because the Durex variety conveys a sense of fun. This makes safer sex seem appealing and amounts to more than receiving a dull, sexual health lecture and something for their back pocket; our young people want to use and enjoy the condoms.
Strictly confidential - getting the results
As part of the chlamydia screen, it is explained to the young people how their test result will be texted confidentially to their mobile phone and what to do in the event of a positive result. Our screeners do not treat the infection and it is important to stress that screeners do not masquerade as HCPs. Screeners simply signpost the young person to one of our 300 treatment facilities that will provide them with the medication they need straight away. This avoids the need for the young person to obtain a prescription and allows them to get the infection treated quickly.
Keeping up with demand...
The programme has been very successful and young people have been pleased to have this service option. Since the scheme first launched, we achieved our initial 10% target and feel confident that our target for the current financial year, 25% of 15-24 year olds, is also achievable. This will rise to 35% by the next financial year and demonstrates the faith of the Greater Manchester health authority that RUClear is making a difference.
Keeping up with the demand has been a big priority and we have now expanded to over 1000 screening centres across the area. We have even taken the RUClear programme online with a website designed to help young people order chlamydia testing kits and have their result texted to them if they need treatment. We dispense condoms and information with the testing kits to ensure that they still have access to high quality condoms as well as meeting their ongoing information needs.
Above all, we are pleased that the success of the RUClear project shows that chlamydia screening targets are achievable with a little creative thinking. Sexual health is a concern for everyone, and finding creative ways around the screening challenges can help make even the largest of targets more manageable. Involving other professionals can help HCPs shoulder the burden, and with the success of RUClear in Greater Manchester, we believe similar schemes nationwide would put the chlamydia screening targets within everyone's reach.
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About the Author
Diane Cordwell RGN,RSCN, FP cert.Diane has worked in Sexual Health since 1997, specialising in work with Young People. Diane is one of the founder members of RUclear?, joining the team at its inception as the Coordinator for the Central/South sector Greater Manchester and took over as the Lead for the programme in January 2009.
The views expressed in this article do not necessarily reflect the views of SSL International.
