Family Practice Advance Access originally published online on June 17, 2005
Family Practice 2005 22(5):578-579; doi:10.1093/fampra/cmi051
Correspondence |
Randomized trial in family practice of a brief intervention to reduce STI risk in young adults
Department of Community Health Sciences, St George's Hospital Medical School, London SW17 ORE
Correspondence to Mr S Raveney, 58A Tooting High Street, Tooting Broadway, London SW17 ORN; Email: m0300082{at}sghms.ac.uk
Proude and colleagues found a brief intervention by Australian family physicians to reduce STI risk in young adults had little effect on self reported behaviour.1 This is in line with a cluster trial of condom promotion in 1300 women from 28 London practices in which there was no difference in condom use at the last sexual intercourse, even in those reporting multiple partners.2
Possible barriers to sexual health promotion by GPs were also highlighted by small questionnaire survey of healthcare students from St George's Hospital conducted as a medical student research project in January 2005. The aim was to examine attitudes of healthcare students to seeking help if at risk of having a STI, and the reasons linked to this. The response rate was 96% (89/93). Mean age of respondents was 21 (range 18–34) and 35% were male. 63% described their ethnicity as white, 14% as Indian Sub-continent, 11% as SE Asian/Chinese, 8% Black African, 2% Afro-Caribbean and 2% as other ethnic groups. 84% were registered with a GP but of these only 53% knew their GP's name. If at risk of having a STI only 33% would go to their GP. In response to an open question, the reasons given for seeking healthcare elsewhere were embarrassment (29%), perceived lack of GPs' skill in STI management (12%), length of time to get an appointment (7%), laziness (7%), lack of confidentiality at GP practice (7%) and lack of trust in their GP (4%). Although 45% of the students would seek medical help as soon as possible if at risk of having a STI, 38% would only seek help if symptoms develop and the remaining 17% would seek help at a later time. This is important given the lack of symptoms in certain STIs such as chlamydia and possible effects of delay in seeking medical help.
When an intervention is apparently ineffective, as in Proude's trial, qualitative data from both doctors and patients can be helpful for explaining possible reasons. Our questionnaire survey also suggests that many young people do not regard their GPs as the major provider of healthcare for STI related issues. In addition there is a substantial percentage of healthcare students who would not seek medical help as soon as possible if they were at risk of having a STI.
References
1 Proude EM, D'Este C, Ward JE. Randomized trial in family Practice of a brief intervention to reduce STI risk in young adults. Fam Pract 2004; 21: 537–544.
2 Oakeshott P, Kerry S, Hay S and Hay P. Condom promotion in women attending inner city general practices for cervical smears: a randomized controlled trial. Fam Pract 2000; 17: 56–59.
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